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UBRARV  of 


Digitized  by  the  Internet  Archive 
in  2017  with  funding  from 

The  National  Endowment  for  the  Humanities  and  the  Arcadia  Fund 


https://archive.org/details/southdakotajourn1119sout 


'■i 


FOR  PERSISTENT  INFECTIONS 

CHLOROMYCETIN 

COMBATS  MOST  CLINICALLY  IMPORTANT  PATH06ENS 


^ m 


/t^ 


Acquired  resistance  seldom  imposes  restrictions  on 
antimicrobial  therapy  when  CHLOROMYCETIN  (chlor- 
amphenicol, Parke-Davis)  is  selected  to  combat  gram- 
negative pathogens  involving  enteric  and  adjacent 
structures  of  the  urinary  tract.  The  acknowledged  eflFec- 
tiveness  with  which  CHLOROMYCETIN  suppresses  highly 
invasive  staphylococci^"^  extends  to  persistently  patho- 
genic coliforms.®’!®'^®  Experience  with  mixed  groups  of 
Proteus  species,  for  example,  . . shows  chloramphenicol 
to  be  the  drug  of  choice  against  these  bacilli . . 

CHLOROMYCETIN  is  a potent  therapeutic  agent  and,  because 
certain  blood  dyscrasias  have  been  associated  with  its  administra- 
tion, it  should  not  be  used  indiscriminately  or  for  minor  infections. 
Furthermore,  as  with  certain  other  drugs,  adequate  blood  studies 
should  be  made  when  the  patient  requires  prolonged  or  intermit- 
tent therapy. 


REFERENGIig 

(1)  Petersdorf,  R.  G.;  Bennett,  I.  L.,  Jr.,  & Rose,  M.  C.:  Bull.  Johns  Hopkins 
Hosp.  100:1,  1957.  (2)  Yow,  E.  M.:  GP  15:102,  1957.  (3)  Altemeier,  W.  A., 
in  Welch,  H.,  and  Marti-Ibanez,  E,  ed.:  Antibiotics  Annual  1956-1957,  New 
York,  Medical  Encyclopedia,  Inc.,  1957,  p.  629.  (4)  Kempe,  C.  H.:  California 
Med.  84:242,  1956.  (5)  Spink,  W.  W.:  Arm.  New  York  Acad.  Sc.  65:175, 

1956.  (6)  Rantz,  L.  A.,  & Rantz,  H.  H.:  Arch.  Int.  Med.  97:694,  1956. 

(7)  Wise,  R.  I.;  Cranny,  C.,  & Spink,  W.  W.:  Am.  J.  Med.  20:176,  1956. 

(8)  Smith,  R.  X;  Platou,  E.  S.,  & Good,  R.  A.:  Pediatncs  17:549,  1956. 

(9)  Royer,  A.:  Scientific  Exhibit,  89th  Ann.  Conv.  Canad.  M.  A.,  Quebec  City, 
Quebec.  June  11-15,  1956.  (10)  Bennett,  I.  L.,  Jr.:  West  Virginia  M.  J.  53:55, 

1957.  (11)  Altemeier.  W.  A.:  Postgrad.  Med.  20:319,  1956.  (12)  Felix,  N.  S.: 
Pediat.  Clin.  North  America  3:317,  1956.  (13)  Metzger,  W.  I.,  & Jenkins, 
C.  J.,  Jr.:  Pediatrics  18:929,  1956.  (14)  Woolington,  S.  S.;  Adler,  S.J.,&  Bower, 
A.  G.,  in  Welch,  H.,  and  Marti-Ibanez,  E,  ed.:  Antibiotics  Annual  1956-1957, 
New  York,  Medical  Encyclopedia,  Inc.,  1957,  p.  365.  (15)  Waisbren,  B.  A., 
& Strelitzer,  G.  L.:  Arch.  Int.  Med.  99:744,  1957. 


► 


PARKE,  DAVIS  ft  COMPANY  DETROIT  32,  MICHIGAN 


« % 


soies 


COMPARATIVE  SENSITIVITY  OF  MIXED  PROTEUS  SPECIES  TO  CHLOROMYCETIN 
AND  SIX  OTHER  WIDELY  USED  ANTIBIOTIC  AGENTS* 


*This  graph  is  adapted  from  Waisbren  and  Strelitzer.^®  It  represents  in  vitro  data  obtained  with  clinical  material  isolated  between  the  years 
1951  and  1956.  Inhibitory  concentrations,  ranging  from  3 to  25  meg.  per  ml.,  were  selected  on  the  basis  of  usual  clinical  sensitivity. 


THE  SOUTH  DAKOTA 


JOURNAL  OF  MEDICINE 

AND 

PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


Volume  XI 


January  1958 


Number  1 


CONTENTS 


MEDICAL  SECTION 

Pulmonary  Emphysema  Following  A&A 1 

C.  L.  Swanson,  M.D.,  Pierre,  South  Dakota 

The  Diagnosis  of  Emotional  Disorders  In  Children 3 

Jerman  Rose,  M.D.,  Omaha,  Nebraska 

Summary  of  Medicare  in  South  Dakota  6 

A.  A.  Lamport,  M.D.,  Rapid  City,  South  Dakota 

Contributors  to  AMEF  In  1957  9 

Report  of  Actions  of  the  House  of  Delegates 11 

A.  A.  Lamport,  M.D.,  Delegate,  Rapid  City,  South  Dakota 

Editorial  Page 14 

Medical  Library  Bookshelf 15 

This  is  Your  Medical  Association 18 

PHARMACY  SECTION 

The  Prescription  Pharmacist  Today 24 

Wallace  Croatman  and  Paul  Sheatsley,  New  York  City,  N.  Y. 

The  New  Era  In  Medical  Research 27 

John  T.  Connor,  Rahway,  New  Jersey 

Recent  Pharmaceutical  Specialties  34 

Pharmacy  News 37 


Entered  as  second-class  matter  January  22,  1948  at  the  post  office  at  Sioux  Falls,  South  Dakota 

under  the  act  of  August  24,  1912 

Published  monthly  by  the  South  Dakota  Medical  Association,  Publication  Office 
300  First  National  Bank  Building,  Sioux  Falls,  South  Dakota 


S.D.J.O.M.  JANUARY  1958  - ADV. 


3 


Since  we  put  him  on  NEOHYDRIN  he's  been 


able  to  stay  on  the  job  without  interruption.' 


oral 

organomercurial 

diuretic 


NEOHYDRIN^ 

BRAND  OF  CHLORMERODRIN 


LAKESIDE 


Z46S7 


THE  SOUTH  DAKOTA 


JOURNAL  OF  MEDICINE 

AND 


PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION, 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


SUBSCRIPTION  $2.00  PER  YEAR  SINGLE  COPY  20c 


Volume  XI  January  1958  Number  1 


STAFF 

Editor - — R.  G.  Mayer,  M.D. Aberdeen,  S.  D. 

Assistant  Editor Patricia  Lynch  Saunders Sioux  Falls,  S.  D. 

Associate  Editor Harold  S.  Bailey,  Ph.D.  Brookings,  S.  D. 

Associate  Editor D.  L.  Kegaries,  M.D.  Rapid  City,  S.  D. 

Associate  Editor J.  A.  Nelson,  M.D Sioux  Falls,  S.  D. 

Associate  Editor - -D.  H.  Manning,  M.D Sioux  Falls,  S.  D. 

Business  Manager John  C.  Foster Sioux  Falls,  S.  D. 


EDITORIAL  COMMITTEE 


D. 

D. 

D. 

H R Wnlii,  M n 

D. 

D. 

Mnbridger  S. 

D. 

D. 

T W RPiil,  M n 

D. 

R.  E.  Van  Demark.  M.D . . — . 

- . - Sioux  Falls.  S. 

D. 

PUBLICATIONS  COMMITTEE 

R.  G.  Mayer,  M.D.,  T.  H.  Saltier,  M.D.,  R.  E.  Van  Demark,  M.D.  and  the  Executive  Com- 
mittee of  The  South  Dakota  Pharmaceutical  Association. 


OFFICERS 


South  Dakota  Pharmaceutical  Association 

Alcester,  S.  D. 

Aberdeen,  S.  D. 

Pierre,  D. 

..Pierre,  S.  D. 

South  Dakota  State  Medical  Association 

A.  A.  Lampert,  M.D. 

Rapid  City,  S.  D. 

.Sioux  Falls,  S.  D. 

Rapid  City,  S.  D. 

Brookings,  S.  D. 

r.  R.  Rtnlfy,  M.D. 

Sioux  Valley  Medical  Association 

Marion,  S.  D. 

R.  P.  naprnJi,  M.D. 

Laurel,  Nebr. 

T reasurer.. — 

.-A.  K.  Myrabo,  M.D.  — 

Sioux  Falls,  S.  D. 

S.DJ.O.M.  JANUARY  1958  - ADV. 


5 


symptomatic  relief ...  plus! 


ACHROCIDIN  is  a well-balanced,  comprehensive  formula  for 
treating  acute  upper  respiratory  infections. 

Debilitating  symptoms  of  malaise,  headache,  pain,  mucosal 
and  nasal  discharge  are  rapidly  relieved. 

Early,  potent  therapy  is  offered  against  disabling  complications 
to  which  the  patient  may  be  highly  vulnerable,  particularly 
during  febrile  respiratory  epidemics  or  when  questionable  middle 
ear,  pulmonary,  nephritic,  or  rheumatic  signs  are  present. 

ACHROCIDIN  is  convenient  for  you  to  prescribe-— easy  for  the 
patient  to  take.  Average  adult  dose:  two  tablets,  or  teaspoonfuls 
of  syrup,  three  or  four  times  daily. 


tablets 

ACHROMYCIN  ® Tetracycline  . 125  mg. 


Phenacetin 120  mg. 

Caffeine 30  mg. 

Salicylamide 150  mg. 

Chlorothen  Citrate 25  mg. 


Bottle  of  24  tablets 

syrup 

Each  teaspoonful  (5  cc.)  contains; 
ACHROMYCIN  ® Tetracycline 

equivalent  to  tetracycline  HCl  125  mg. 


Phenacetin 120  mg. 

Salicylamide 150  mg. 

Ascorbic  Acid  (C) 25  mg. 

Pyrilamine  Maleate 15  mg. 

Methylparaben 4 mg. 

Propylparaben 1 mg. 


Available  on  prescription  only 


LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMIO  COMPANY,  PEARL  RIVER,  NEW  YORK 


•Reg.  U.  S.  Pat.  Oft. 


A NEW  SKELETAL 
MUSCLE  RELAXANT 


Robaxin  — synthesized  in  the  Robins  Research  Laboratories,  and 


intensively  studied  for  five  years— introduces  to  the  physician  an 


entirely  new  agent  for  effective  and  well-tolerated  skeletal  muscle 
relaxation.  Robaxin  is  an  entirely  new  chemical  formulation,  with 
outstanding  clinical  properties: 

* Highly  potent  and  long  acting.^'^ 

* Relatively  free  of  adverse  side  effects.’’^'^'^*'^ 

* Does  not  reduce  normal  muscle  strength  or  reflex  activity 
in  ordinary  dosage.^ 

* Beneficial  in  94.4%  of  cases  with  acute  back  pain 
due  to  muscle  spasm.’'®''*'*'^ 


CLINICAI.  RESI 


DISEASE  ENTITY 


Acute  back  pain  due  t 


(a)  Muscle  spasm  seceii  m 
to  sprain 


(b)  Muscle  spasm  due 
trauma 


(c)  Muscle  spasm  due  t)  l‘! 
nerve  irritation 


(d)  Muscle  spasm  secon  !<! 
to  discogenic  diseol 
and  postoperative 
orthopedic  procedui 


Miscellaneous  (bursitis/  i'K 
torticollis,  etc.)  N 


TOTAll 


(Methocarbamol  Robins,  U.S.  Pat.  No.  2770649) 


Highly  specific  action 

Robaxin  is  highly  specific  in  its  action  on  the 
intemuncial  neurons  of  the  spinal  cord  — with 
inherently  sustained  repression  of  multisyn- 
aptic  reflexes,  but  with  no  demonstrable  effect 
on  monosynaptic  reflexes.  It  thus  is  useful  in 
I the  control  of  skeletal  muscle  spasm,  tremor  and 
other  manifestations  of  hyperactivity,  as  well 
as  the  pain  incident  to  spasm,  without  impair- 
ing strength  or  normal  neuromuscular  function. 


Beneficial  in  94.4%  of  cases  tested 


When  tested  in  72  patients  with  acute  back 
pain  involving  muscle  spasm,  Robaxin  in- 
duced marked  relief  in  59,  moderate  relief  m 
6,  and  slight  relief  in  3 — or  an  over-all  bene- 
ficial effect  in  94.4%.^’®’^’®’'^  No  side  effects 
occurred  in  64  of  the  patients,  and  only  slight 
side  effects  in  8.  In  studies  of  129  patients, 
moderate  or  negligible  side  effects  occurred 
in  only  6.2%.^’^’®’^’®''^ 


HiiiH 


ROBAXIN  IN  ACUTE  BACK  PAIN<-3  « 


DURATION 
OF 

rPFATMFMT 


2-42  days 


-42  days 
1-240  days 
-28  days 


-60  days 


DOSE  PER  DAY  (divided) 


3-6  Gm. 


2-6  Gm. 


2.25-6  Gm. 


1.5-9  Gm. 


4-8  Gm. 


RESPONSE 
marked  mod.  slight  neg. 


17 


24 


59 


SIDE  EFFECTS 


None,  1 6 
Dizziness,  1 
Slight  nausea,  1 


None,  12 
Nervousness,  1 


None,  5 


None,  25 
Dizziness,  1 
Lightheaded- 


ness, 2 
Nausea,  2 * 


None,  6 


* Relieved  on 
reduction 
of  dose 


Indications Acute  back  pain  associ- 
ated with : (a)  mu-scle  spasm  secondary  to 
sprain;  (b)  muscle  spasm  due  to  traiuna;* 

(c)  muscle  spasm  due  to  nerve  irritation; 

(d)  muscle  spasm  .secondary  to  discogenjC  } 
disease  and  postoperative  orthopedic 
procedure.?;  and  mi-scellaneous  conditions, 
such  as  bursitis,  fibrositis,  torticollis,  etc. 


Dosage  — Adults:  Two  tablets  4 times 
daily  to  3 tablets  every  4 hours.  Total  daily 
doisage : 4 to  9 Gm.  in  divided  doses. 


' Vri  References:  l.  Carpenter,  E.  B.:  Publication  pending.  2.  Carter, 
. C,  H.:  Personal  cmnmonicatton.  3.  Forsyth,  H.  P.;  Publication 


Precautions  — There  are  no  specific  con-" 
traindications  to  Robaxin  and  untoward 
reactions  are  not  to  be  anticipated.  Minor 
side  clTects  such  as  lightheadedness,  dizzi- 
ness, nausea  may  occur  rarely  in  patients 
with  unusual  sensitivity  to  drugs,  but  dis- 
appear on  reduction  of  dosage.  When  ther- 
apy is  prolonged  routine  white  blood  cell 
counts  should  be  made  since  some  decrease  | 
was  noted  in  3 patienta  Put  of  a group  of 
72  who  had  received  %he  drug  for  periods 
of  30  days  or  longer.  > 


pending.  4.  Freund,  J.:  Personal  commuaication.  5.  Morgan, 
^A.  M.,  ^IVuitt,  E.  B.,  Jt„  and  little,  J.  M.:  American  Pbarm.  Assn. 
7y''-  46^1^4.  1957.  6.  Nadunan.  H.  M.:  Personal  conununication. 


SltppZy  — Robaxin  Tablets,  0.5  Gm.,  in 
bottles  .of  50. 


n.  a AH  MiRIMMmalMft  Richmnnri  70  to 


DIRECTORY 


THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION 
Organized  1882  300  First  Nat’l  Bank  Bldg. 


Sioux  Falls,  South  Dakota 
OFFICERS,  1957-1958 
President 

M.  M.  Morrissey,  M.D.  —..Pierre 

President-Elect 

A.  A.  Lampert,  M.D.  Rapid  City 

Secretary-Treasurer 

A.  P.  Reding,  M.D Marion 

Vice  President 

R.  A.  Buchanan,  M.D.  Huron 

AMA  Delegate 

A.  A.  Lampert,  M.D.  Rapid  City 

Alternate  Delegate  to  AMA 

A.  P.  Reding,  M.D Marion 

Chairman  of  the  Council 

Magni  Davidson,  M.D.  Brookings 

Speaker  of  the  House 

C.  R.  Stoltz,  M.D.  Watertown 

Councilor-at-Large 

A.  P.  Peeke,  M.D.  Volga 

COUNCILORS 
First  District  (Aberdeen) 

P.  V.  McCarthy,  M.D.  (1959)  Aberdeen 

Second  District  (Watertown) 

J.  J.  Stransky,  M.D.  (1959)  Watertown 

Third  District  (Brookings-Madison) 

Magni  Davidson,  M.D.  (1960)  Brookings 

Fourth  District  (Pierre) 

L.  C.  Askwig,  M.D.  (1959)  Pierre 

Fifth  District  (Huron) 

Paul  Hohm,  M.D.  (1960)  Huron 

Sixth  District  (Mitchell) 

P.  P.  Brogdon,  M.D.  (1960)  Mitchell 

Seventh  District  (Sioux  Falls) 

C.  J.  McDonald,  M.D.  (1960)  ..  Sioux  Falls 

Eighth  District  (Yankton) 

T.  H.  Sattler,  M.D.  (1959)  ...Yankton 

Ninth  District  (Black  Hills) 

J.  D.  Bailey,  M.D.  (1958)  ...Rapid  City 

Tenth  District  (Rosebud) 

R.  H.  Hayes,  M.D.  (1958)  Winner 

Eleventh  District  (Northwest) 

G.  C.  Torkildson,  M.D.  (1958)  McLaughlin 

Twelfth  District  (Whetstone) 

E.  A.  Johnson,  M.D.  (1958)  Milbank 


STANDING  COMMITTEES  — 1957-1958 


Scientific  Work 

M.  M.  Morrissey,  M.D.,  Chr.  Pierre 

A.  A.  Lampert,  M.D.  Rapid  City 

R.  A.  Buchanan,  M.D.  Huron 

A.  P.  Reding,  M.D.  Marion 

Legislation 

H.  Russell  Brown,  M.D.,  Chr Watertown 

R.  E.  Van  Demark,  M.D. Sioux  Falls 

E.  T.  Ruud,  M.D Rapid  City 

Paul  Bunker,  M.D Aberdeen 

C.  L.  Swanson,  M.D.  Pierre 

H.  R.  Lewis,  M.D Mitchell 


Publications 

R.  G.  Mayer,  M.D.,  Chr.  (1960)  Aberdeen 

R.  E.  Van  Demark,  M.D.  (1958)  Sioux  Falls 

T.  H.  Sattler,  M.D.  (1959)  Yankton 

Medical  Defense 

A.  P.  Reding,  M.D.,  Chr.  (1958)  Marion 

Russell  Orr,  M.D.  (1959)  Sioux  Falls 

D.  R.  Mabee,  M.D.  (1960)  .....Mitchell 

Medical  School  Affairs 
Medical  Education  and  Hospitals 

C.  B.  McVay,  M.D.,  Chr.  (1960)  Yankton 

R.  C.  Jahraus,  M.D.  (1960)  Pierre 

Ronald  Price,  M.D.  (1958)  Armour 

F.  D.  Gillis,  Jr.,  M.D.  (1958)  ._.  Mitchell 

W.  H.  Saxton,  M.D.  (1959)  ...Huron 

F.  R.  Williams,  M.D.  (1959)  Rapid  City 

Medical  Economics 

M.  Davidson,  M.D.,  Chr.  (1958)  Brookings 

Abner  Willen,  M.D.  (1959)  Clark 

R.  H.  Hayes,  M.D.  (1960)  Winner 


Necrology 

D.  J.  Glood,  M.D.,  Chr.  (1958)  Viborg 

J.  C.  Murphy,  M.D.  (I960)  Murdo 

J.  T.  Cowan,  M.D.  (1959)  -..Pierre 

Public  Health 

R.  K.  Rank,  M.D.,  Chr.  (1959)  Aberdeen 

F.  C.  Totten,  M.D.  (1958)  Lemmon 

N.  E.  Wessman,  M.D.  (1960)  _..  Sioux  Falls 


Cancer 

P.  V.  McCarthy,  M.D.,  Chr.  (1960)  ... 

W.  A.  Geib,  M.D.  (1958)  

J.  V.  McGreevy,  M.D.  (1959)  

Tuberculosis 


— Aberdeen 
Rapid  City 
Sioux  Falls 


W.  L.  Meyer,  M.D.,  Chr.  (1960)  

R.  G.  Mayer,  M.D.  (1958)  

Saul  Friefeld,  M.D.  (1959)  

Maternal  & Child  Welfare 

Brooks  Ranney,  M.D.,  Chr.  (1959)  

L.  W.  Tobin,  M.D.  (1958)  

W.  A.  Anderson,  M.D.  (1960)  — 

Diabetes 


Sanator 

Aberdeen 

.....Brookings 

Yankton 

Mitcnell 

..Sioux  Falls 


E.  W.  Sanderson,  M.D.  (1958)  Sioux  Falls 

M.  E.  Sanders,  M.D.  (1959)  Redfield 

Clifford  Gryte,  M.D.  (I960)  .....Huron 


Executive  Committee 


M.  M.  Morrissey,  M.D.,  Chr.  Pierre 

A.  A.  Lampert,  M.D.  Rapid  City 

R.  A.  Buchanan,  M.D Huron 

C.  R.  Stoltz,  M.D Watertown 

A.  P.  Reding,  M.D Marion 

Magni  Davidson,  M.D Brookings 

Grievance  Committee 

L.  J.  Pankow,  M.D.,  Chr.  (1962)  Sioux  Falls 

R.  E.  Jernstrom,  M.D.  (1958)  Rapid  City 

D.  A.  Gregory,  M.D.  (1959)  Milbank 

A.  W.  Spiry,  M.D.  (1960)  Mobridge 

D.  S.  Baughman,  M.D.  (1961)  Madison 

Mental  Health 

George  Smith,  M.D.,  Chr.  (1960)  Sioux  Falls 

E.  S.  Watson,  M.D.  (1958)  Brookings 

Clark  Johnson,  M.D.  (1958)  Yankton 

R.  C.  Knowles,  M.D.  (1959)  Sioux  Falls 

H.  E.  Davidson,  M.D.  (1959)  Lead 

C.  E.  Baker,  M.D.  (1960)  Yankton 

Benevolent  Fund 

W.  E.  Donahoe,  M.D.,  Chr.  (1960)  Sioux  Falls 

J.  C.  Hagin,  M.D.  (1958)  Miller 

F.  C.  Totten,  M.D.  (1959)  Lemmon 

Rheumatic  Fever  and  Heart  Disease 
J.  Argabrite,  M.D.,  Chr.  (1958)  Watertown 

B.  T.  Lenz,  M.D.  (1959)  Huron 

H.  W.  Farrell,  M.D.  (1960)  Sioux  Falls 

SPECIAL  COMMITTEES 
Radio  Broadcasts  and  Telecasts  Committee 

J.  J.  Stransky,  M.D.,  Chr.  Watertown 

J.  P.  Steele,  M.D Yankton 

J.  C.  Rodine,  M.D Aberdeen 

Robert  Olson,  M.D.  Sioux  Falls 

Wm.  Fritz,  M.D.  Mitchell 

F.  D.  Leigh,  M.D.  — Huron 

S.  B.  Simon,  M.D Pierre 

H.  L.  Ahrlin,  M.D.  Rapid  City 

American  Medical 
Education  Foundation 

A.  P.  Reding,  M.D.,  Chr.  Marion 

A.  A.  Lampert,  M.D Rapid  City 

O.  J.  Mabee,  M.D Mitchell 

H.  L.  Saylor,  Jr.,  M.D Huron 

S.  F.  Sherrill,  M.D.  Belle  Fourche 

Editorial 

R.  G.  Mayer,  M.D Aberdeen 

G.  S.  Paulson,  M.D.  Rapid  City 

Harold  Lowe,  M.D.  Mobridge 

H.  R.  Wold,  M.D.  Madison 

R.  E.  Van  Demark,  M.D.  Sioux  Falls 

T.  W.  ReuI,  M.D.  Watertown 

Mary  Price,  M.D.  Armour 

Amos  Michael,  M.D Vermillion 

M.  L.  Spain,  M.D Rapid  City 

Medical  Licensure 

F.  F.  Pfister,  M.D Webster 

Magni  Davidson,  M.D Brookings 

C.  E.  Kemper,  M.D.  Viborg 

Veterans  Administration  and  Military  Affairs 

L.  C.  Askwig,  M.D.,  Chr.  Pierre 

M.  R.  Gelber,  M.D.  Aberdeen 

G.  H.  Steele,  M.D Aberdeen 

T.  J.  Billion,  M.D . Sioux  Falls 

Spafford  Memorial  Fund 

T.  E.  Eyres,  M.D.  Vermillion 

Prepayment  and  Insurance  Plans 

C.  J.  McDonald,  M.D.,  Chr.  Sioux  Falls 

D.  H.  Brelt,  M.D.  Sioux  Falls 

Paul  Hohm,  M.D Huron 

E.  A.  Johnson,  M.D Milbank 

A.  A.  Lampert,  M.D.  Rapid  City 

Robert  Monk,  M.D.  Yankton 

T.  H.  Sattler,  M.D.  — Yankton 

Rural  Medical  Service 

A.  P.  Peeke,  M.D.,  Chr Volga 

G.  J.  Bloemendaal,  M.D.  Ipswich 

E.  F.  Kalda,  M.D —..Platte 

Nursing  Training 

J.  A.  Muggly,  M.D.,  Chr ...Madison 

C.  L.  Vogele,  M.D.  .....Aberdeen 

G.  F.  Gryte,  M.D.  _Huron 

Workmen’s  Compensation 

J.  N.  Hamm,  M.D.,  Chr _..Sturgis 

H.  R.  Lewis,  M.D.  Mitchell 

R.  Giebink,  M.D Sioux  Falls 

Blood  Banks 

W.  A.  Geib,  M.D.,  Chr —Rapid  City 

R.  L.  Carefoot,  M.D.  Huron 

A.  K.  Myrabo,  M.D.  Sioux  Falls 

Rehabilitation  Committee 

R.  E.  Van  Demark,  M.D.,  Chr.  Sioux  Falls 

Paul  Bunker,  M.D Aberdeen 

W.  A.  Dawley,  M.D.  Rapid  City 

H.  L.  Ahrlin,  M.D — Rapid  City 

Mary  Schmidt,  M.D.  Watertown 

Press  Radio  Committee 

R.  E.  Jernstrom,  M.D.,  Chr.  Rapid  City 

E.  A.  Rudolph,  M.D.  Aberdeen 

Steve  Brzica,  M.D Sioux  Falls 

Care  of  the  Indigent 

H.  P.  Adams,  M.D.,  Chr Huron 

A.  P.  Peeke,  M.D Volga 

H.  Russell  Brown,  M.D Watertown 

F.  F.  Pfister,  M.D Webster 

P.  V.  McCarthy,  M.D.  Aberdeen 

E.  J.  Perry,  M.D.  Redfield 

R.  F.  Hubner,  M.D Yankton 

C.  A.  Johnson,  M.D Lemmon 


S.D.J.O.M.  JANUARY  1958  - ADV. 


9 


the  chill 

the  cough 

the  aching  muscles 

the  fever 


Viral  upper  respiratory  infection. . . . For  this  patient,  your  management  will  be  twofold — 
prompt  symptomatic  relief  plus  the  prevention  and  treatment  of  bacterial  complications. 
PEN•VEE•C^d^7^  backs  your  attack  by  broad,  multiple  action.  It  relieves  aches  and  pains,  and 
reduces  fever.  It  counters  depression  and  fatigue.  It  alleviates  cough.  It  calms  the  emotional 
unrest.  And  it  dependably  combats  bacterial  invasion  because  it  is  the  only  preparation  of  its 
kind  to  contain  penicillin  V. 

SUPPLIED:  Capsules,  bottles  of  36.  Each  capsule  contains  62.5  mg.  (100,000  units)  of  penicillin  V,  194  mg.  of 
salicylamide,  6.25  mg.  of  promethazine  hydrochloride,  130  mg.  of  phenacetin,  and  3 mg.  of  mephentermine  sulfate. 

Pen  •\^e  • Cidin 

Penicillin  V with  Salicylamide,  Promethazine  Hydrochloride,  Phenacetin,  and  Mephentermine  Sulfate,  Wyeth  Philadelphia  1,  Pa. 


This  advertisement  con- 
forms to  the  Code  for 
Advertising  of  the  Physi- 
cians’ Council  for  Infor- 
mation on  Child  Health. 


10 


S.DJ.O.M.  JANUARY  1958  - ADV. 


Achrostatin  V combines  AcHROMYCiNt  V . . . 

the  new  rapid-acting  oral  form  of 
AcHROMYCiNt  Tetracycline  . . . noted  for  its 
outstanding  elfectiveness  against  more  than 
50  different  infections  . . . and  Nystatin  . . . the 
antifungal  specific.  Achrostatin  V provides 
particularly  effective  therapy  for  those 
patients  who  are  prone  to  monilial  overgrowth 
during  a protracted  course 
of  antibiotic  treatment. 


supplied: 

Achrostatin  V Capsules 
contain  250  mg.  tetracycline 
HCl  equivalent  (phosphate- 
buffered)  and  250,000 
units  Nystatin. 

dosage: 

Basic  oral  dosage  (6-7  mg. 
per  lb.  body  weight  per  day) 
in  the  average  adult  is 
4 capsules  of  Achrostatin  V 
per  day,  equivalent  to 
1 Gm.  of  Achromycin  V. 
*Trademark 
fReg.  U.  S.  Pat.  Off. 


LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY,  PEARL  RNVER.  N.  Y. 


S.D.J.O.M.  JANUARY  1958  - ADV. 


11 


minor 
chemical 
changes 
can  mean 
major 
therapeutic 
improvements 


The  most 
efficient  of  all 
anti-inflammatory 
steroids 

Supplied:  Tablets  of  4 mg.,  in  bottles 
of  30,  100  and  500. 

lleTRADEMARK  FOR  METHYLPREONISOLONE«  UPJOHN 


Lower  dosage 
(K  lower  dosage 
than 

prednisolone) 

Better  tolerated 

(less  sodium 
retention,  less 
gastric  irritation) 

For 

complete  information,  consult 
your  Upjohn  representative, 
or  write  the  Medical  Department, 

The  Upjohn  Company, 

Kalamazoo,  Michigan. 

Upjohn 


NOW... for  the  first  time  in  tetracycii 


m 


SI 


ni 


I 


m 


i4-hour  blood  levels 

on  a SINGLE  intramuscular  dose, 
in  minimal  injection  volume 

This  achievement  is  made  possible  by  the  unique  solubility  of  Tetrex  (tetracycline 
phosphate  complex) , which  permits  more  antibiotic  to  be  incorporated  in  less  volume 
of  diluent.  Clinical  studies  have  shown  that  injections  are  well  tolerated,  with  no  more 
pain  on  injection  than  with  previous,  less  concentrated  formulations. 

: Tetrex  Intramuscular  ‘250’  can  be  reconstituted  for  injection  by  adding  1.6  cc.  of 

sterile  distilled  water  or  normal  saline,  to  make  a total  injection  volume  of  2.0  cc. 

When  the  entire  250  mg.  are  to  be  injected,  and  minimal  volume  is  desired,  as  little  as 
1.0  cc.  of  diluent  need  be  used.  (Full  instructions  for  administration  and  dosage  for 
adults  and  children,  accompany  packaged  vial.) 

1 Each  one-dose  vial  of  TETREX  Intramuscular  '250'  contains: 

TETREX  (tetracycline  phosphate  complex)  (tetracycline  HCI  activity) 250  mg. 

Xylocaine*  hydrochloride 40  mg. 

plus  ascorbic  acid  300  mg.  and  magnesium  chloride  46  mg.  as  buffering  agents. 

*®  of  Astra  Pharm.  Prod.  Inc.  for  lidocaine 


SUPPLY:  Single-dose  vials  containing  Tetrex  — tetracycline  phosphate  complex  — each 
equivalent  to  250  mg.  tetracycline  HCI  activity.  Also  available  in  100-mg.  single-dose  vials. 


iifTRAMUSCULAR  '250' 
WITH  XYLOCAINE 

ISTOL  LABORATORIES  INC.,  SYRACUSE,  NEW  YORK 


tAyd,  F.  J.,  Jr.:  The  Treatment  of  Ambulatory  and 
Hospitalized  Psychiatric  Patients  with  Xrilafon, 
presented  at  Ann.  Meet.,  Am.  Psychiat.  Assoc., 
Chicago,  111.,  May  13-17,  1957. 


". . . especially  suitable 
for  out-patient  and 
office  use."' 


(pronounced  Tn'll'-ah-fon) 


perphenazine 


* 


the  full-range  tranquilizer 


EXCEPTIONAL  THERAPEUTIC  RANGE 


. . . dosage  range  adaptable  for  tension  and  anxiety  states, 
ambulatory  psychoneurotics,  agitated  hospitalized  psychotics 


EXCEPTIONAL  POTENCY 

• At  least  five  times  more  potent  than  earlier  phenothiazines 

EXCEPTIONAL  ANTIEMETIC  RANGE 


• From  the  mildest  to  the  severest  nausea  and  vomiting  due 
to  many  causes 


ADEQUATE  SAFETY  IN  RECOMMENDED  DOSAGE  RANGES 


• Jaundice  attributable  to  the  drug  alone  not  reported 

• Unusual  freedom  from  significant  hypotension 

• No  agranulocytosis  observed 

• Mental  acuity  apparently  not  dulled 

TRILAFON— grey  tablets  of  2 mg.  (black  seal),  4 mg.  (green  seal),  8 mg. 
(blue  seal),  bottles  of  50  and  500;  16  mg.  (red  seal),  for  hospital  use, 
bottle  of  500. 


Refer  to  Schering  literature  for  specific  informa- 
tion regarding  indications,  dosage,  side  effects, 
precautions  and  contraindications. 


SCHERING  CORPORATION  • BLOOMFIELD,  NEW  JERSEY 


\ 


% 


outmodin^  older  cot 


16 


S.D.J.O.M.  JANUARY  1958  - ADV. 


—twice  as  much  absorptidn  of  penicillin  as  from  buffered 
potassium  penicillin  G given  oraliy. 

A greater  total  penlciHemia  is  produced  by  250  mg,  of 
‘V-Cillln  K*  t,i,d.  than  by  600,000  units  daily  of  intra- 
muscutar  procaine  penicillin  6.  Also,  high  serum  levels 
are  attained  more  quickly  with  this  new  oral  penicillin. 

These  unique  advantages  of  ‘V-Cillin  K'  assure  maxi- 
mum penicillin  effectiveness,  and  dependable  therapy, 
for  peniciliin-sensitive  infections. 

Scored  tablets  of  125  and  250  mg.  (200,000  and  400,000 
units). 


ELI  LILLY  AND  COMPANY  • INDIANAPOLIS  6,  INDIANA.  U.S.A. 


QUALITY /research  /INTEGRITY 


833203 


S.DJ.O.M.  JANUARY  1958  - ADV. 


17 


SEARLE 


a superior  psychochemical 

for  the  management  of  both 
minor  and  major 

emotional  disturbances 


I 


dihydrochloride 


brand  of  thiopropazate  dihydrochloride 


more  effective  than  most  potent  tranquilizers 


• as  well  tolerated  as  the  milder  agents 

• consistent  in  effects  as  few  tranquilizers  are 


Dartal  is  a unique  development  of  Searle  Research, 
proved  under  everyday  conditions  of  office  practice 

It  is  a single  chemical  substance,  thoroughly  tested  and  found  particularly  suited 
in  the  management  of  a wide  range  of  conditions  including  psychotic,  psycho- 
neurotic and  psychosomatic  disturbances. 

Dartal  is  useful  whenever  the  physician  wants  to  ameliorate  psychic  agitation, 
whether  it  is  basic  or  secondary  to  a systemic  condition. 

In  extensive  clinical  trial  Dartal  caused  no  dangerous  toxic  reactions.  Drowsiness 
and  dizziness  were  the  principal  side  effects  reported  by  non-psychotic  patients, 
but  in  almost  all  instances  these  were  mild  and  caused  no  problem. 

Specifically,  the  usefulness  of  Dartal  has  been  established  in  psychoneuroses  with 
emotional  hyperactivity,  in  diseases  with  strong  psychic  overtones  such  as  ulcera- 
tive colitis,  peptic  ulcer  and  in  certain  frank  and  senile  psychoses. 

Usual  Dosage  • In  psychoneuroses  with  anxiety  and 
tension  states  one  5 mg.  tablet  t.i.d. 

• In  psychotic  conditions  one  10  mg.  tablet  t.i.d. 


ORAL 


SUBLINGUAL 


Bottles  of  100. 


For  continuing  prophylaxis  patients  may 
swallow  the  entire  Dilcoron  tablet. 


Average  prophylactic  dose:  1 tablet  four  times  daily. 


Therapeutic  dose:  l tablet  held  under  the  tongue 
until  citrus  flavor  disappears,  then  swallowed. 


new 

“flavor-timed” 
dual-action 
coronary  vasodilator 


TRADEMARK 


for  Sustained  cofowar^  vasodilation  and 
protection  dgainst  anginal  attack 


for  Immediate  relief  from  anginal  pain 


DILCORON  contains  t\vo  highly  efficient  vasodilators 
in  a unique  core-and^jacket  tablet. 

.7  ' ''' 

Glyceryl  trinitrate  (nitroglycerin)— 0.4  mgi.  (1/150  grain) 

is  in  the  outer  jacket— held  under  thq\tongue  until 
the  citrus  flavor  disappears ; provides 
rapid  relief  in  acute  or  anticipated  attack. 

The  ihiddle  layer|bf||the  tablet  is 
jV  ,,  the  citrus7'“fl4vor-timer.” 

Pentaerythritol  tetranitrate— 15  mg.  (1/4  grain)  is  in  the 

inner  core— swallowed  for  slow  enteric 
absorption  and  lasting  protection. 


S.D.J.O.M.  JANUARY  1958  - ADV. 


19 


BUY 
QUALITY 
IN  YOUR 
PRINTING 


An  old  adage  says  "Clothes  make  the  man."  Per- 
haps this  is  not  true  in  a very  strict  sense,  but 
nevertheless  a well-groomed  man  makes  a better 
impression  than  one  who  is  not.  This  same  reason- 
ing may  well  apply  to  the  printed  forms  which 
leave  your  office.  A dignified,  well-printed  state- 
ment or  envelope  can  lend  a great  deal  of  prestige 
to  your  practice.  It  costs  no  more  to  get  QUALITY 
printing  than  poor  printing. 

We've  had  many  years  of  printing  experience  and 
would  like  to  help  you  with  your  printing  require- 
ments. 


MIDWEST-BEACH  COMPANY 

222  South  Phillips  Ave.  • Sioux  Foils,  S.  Dak. 


when  anxiety  and  tension  "erupts”  in  the  G.  I.  tract... 


IN  ILEITIS 


PATH  I BAM  ATE 

Meprobamate  with  PATHILON®  Lederle 


Combines  Meprobamate  (400  mg.)  the  most  widely  prescribed  tranquilizer  . . . helps  control 
the  “emotional  overlay”  of  ileitis  — without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . with  PATHILON  (25  mg.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 


^Trademark  ® Registered  Trademark  for  Tridihexelhyl  Iodide  Lederle 

tEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 


20 


S.D.J.O.M.  JANUARY  1958  - ADV. 


THE  SOUTH  DAKOTA  JOURNAL 
OF  MEDICINE 

300  First  National  Bank  Sioux  Falls,  S.  D. 

Subscription  $2.00  per  year  20c  per  copy 

CONTRIBUTORS 

MANUSCRIPTS:  Material  appearing  in  all  publi- 
cations of  the  Journal  of  Medicine  should  be  type- 
written, double-spaced  and  the  original  copy,  not 
the  carbon  should  be  submitted.  Footnotes  should 
conform  with  this  request  as  well  as  the  name  of 
author,  title  of  article  and  the  location  of  the  author 
when  manuscript  was  submitted.  The  used  manu- 
script is  not  returned  but  every  effort  will  be  used 


to  return  manuscripts  not  accepted  or  published 
by  the  Journal  of  Medicine. 

ILLUSTRATIONS:  Half-tones  and  zinc  etchings 
will  be  furnished  by  The  South  Dakota  Journal  of 
Medicine  when  satisfactory  photographs  or  draw- 
ings are  supplied  by  the  author.  Each  illustration, 
table,  etc.,  should  bear  the  author’s  name  on  the 
back.  Photographs  should  be  clear  and  distinct. 
Drawings  should  be  made  in  black  India  ink  on 
white  paper.  Used  illustrations  are  returned  after 
publication,  if  requested. 

REPRINTS:  Reprints  should  be  ordered  when 
galley  proofs  are  submitted  to  the  authors.  Type 
left  standing  over  30  days  will  be  destroyed  and 
no  reprint  orders  will  be  taken.  All  reprint  orders 
should  be  made  directly  to  the  South  Dakota 
Journal  of  Medicine,  300  First  Nat’l  Bank,  Sioux 
Falls,  South  Dakota. 


(Continued  from  Page  12) 

Committee  on  Civil  Defense 

L.  C.  Askwig,  M.D.,  Chr.  Pierre 

G.  J.  Bloemendaal,  M.D.  Ipswich 

P.  V.  McCarthy,  M.D.  Aberdeen 

Commission  for  Improvement  of  Patient  Care 
R.  Delaney,  M.D.,  Chr.  (1960)  Mitchell 

M.  Sanders,  M.D.  (1960)  Redfield 

C.  L.  Vogele,  M.D.  (1958)  Aberdeen 

C.  F.  Gryte,  M.D.  (1958)  Huron 

J.  A.  Muggly,  M.D.  (1959)  Madison 

R.  A.  Buchanan,  M.D.  (1959)  Huron 

Committee  on  School  Health 

R.  G.  Mayer,  M.D.,  Chr Aberdeen 

W.  A.  Anderson,  M.D.  Sioux  Falls 

N.  R.  Whitney,  M.D Rapid  City 

Committee  on  Budget  and  Audit 

A.  P.  Reding,  M.D.,  Chr Marion 

A.  A.  Lampert,  M.D Rapid  City 

C.  R.  Stoltz,  M.D.  Watertown 

Hunters  Fall  Medical  Meeting 

W.  A.  Delaney,  M.D.,  Chr.  Mitchell 

H.  R.  Lewis,  M.D.  Mitchell 

L.  W.  Tobin,  M.D Mitchell 

Committee  on  Aging 

Warren  Jones,  M.D.,  Chr.  ...Sioux  Falls 

J.  W.  Argabrite,  M.D.  Watertown 

M.  P.  Merryman,  M.D ...Rapid  City 

DISTRICT  OFFICERS 
DISTRICT  1 

President  A.  Keegan,  M.D.,  Aberdeen,  S.  D. 

Vice-President. G.  H.  Steel,  M.D.,  Aberdeen,  S.  D. 

Secretary-Treasurer  .. W.  E.  Gorder,  M.D.,  Aberdeen,  S.  D. 

DISTRICT  2 

President John  Stransky,  M.D.,  Watertown,  S.  D. 

Vice-President S.  W.  Allen,  Jr.,  Watertown,  S.  D. 

Secretary-Treasurer...  M.  C.  Rousseau,  M.D.,  Watertown,  S.  D. 

DISTRICT  3 

President. S.  E.  Friefeld,  M.D.,  Brookings,  S.  D. 

Vice-President C.  S.  Roberts,  Jr.,  M.D.,  Brookings,  S.  D. 

Secretary-Treasurer C.  M.  Kershner,  M.D.,  Brookings,  S.  D. 


DISTRICT  4 

President..... S.  B.  Simon,  M.D.,  Pierre,  S.  D. 

Vice-President  R.  C.  Jahraus,  M.D.,  Pierre,  S.  D. 

Secretary-Treasurer J,  T.  Cowan,  M.D.,  Pierre,  S.  D. 

DISTRICT  5 

President  H.  L.  Saylor,  Jr.,  M.D.,  Huron,  S.  D. 

Vice-President Ted  Hohm,  M.D.,  Huron,  S.  D. 

Secretary-Treasurer..... David  Buchanan,  M.D.,  Huron,  S.  D. 

DISTRICT  6 

President F.  D.  Gillis,  Jr.,  M.D.,  Mitchell,  S.  D. 

Vice-President D.  R.  Nelimark,  M.D.,  Mitchell,  S.  D. 

Secretary-Treasurer R.  J.  Delaney,  M.D.,  Mitchell,  S.  D. 


DISTRICT  7 

President  F.  C.  Kohlmeyer,  M.D.,  Sioux  Falls,  S.  D. 

Vice-President C.  S.  Larson,  M.D.,  Sioux  Falls,  S.  D. 

Secretary A.  K.  Myrabo,  M.D.,  Sioux  Falls,  S.  D. 

Treasurer D.  L.  Ensberg,  M.D.,  Sioux  Falls,  S.  D. 


DISTRICT  8 

President D.  Reaney,  M.D.,  Yankton,  S.  D. 

Vice-President R.  Monk,  M.D.,  Yankton,  S.  D. 

Secretary A.  C.  Michael,  M.D.,  Vermillion,  S.  D. 

Treasurer W.  Stanage,  M.D.,  Yankton,  S.  D. 


DISTRICT  9 

President  S.  F.  Sherrill,  M.D.,  Belle  Fourche,  S.  D. 

Vice-President R.  Boyce,  M.D.,  Rapid  City,  S.  D. 

Secretary-Treasurer Wayne  Geib,  M.D.,  Rapid  City,  S.  D. 

DISTRICT  10 

President F.  J.  Clark,  M.D.,  Gregory,  S.  D. 

Secretary-Treasurer  Peter  Lakstigala,  M.D.,  White  River,  S.  D. 

DISTRICT  11 

Secretary-Treasurer B.  P.  Nolan,  M.D.,  Mobridge,  S.  D. 


DISTRICT  12 

President  E.  A.  Johnson,  M.D.,  Milbank,  S.  D. 

Vice-President.. W.  H.  Karlins,  M.D.,  Webster,  S.  D. 

Secretary-Treasurer Dagfin  Lie,  M.D.,  Webster,  S.  D. 


ii 


PULMONARY  EMPHYSEMA  FOLLOWING 
T & A 

C.  L.  Swanson,  M.D.,  Pierre,  S.  D. 


A danger  infrequently  thought  of  or  en- 
countered secondary  to  tonsillectomy  and 
adenoidectomy  is  pulmonary  emphysema. 
The  subcutaneous  air  is  of  little  importance, 
but  indicates  an  associated  and  more  serious 
problem  involving  air  in  the  pericardial  sack. 
This,  in  turn,  may  create  a sudden  cardiac 
tampenade  with  resultant  cardiac  depression 
and  death. 

A two  and  a half  year  old  boy  was  admitted 
the  day  before  surgery,  on  January  8th,  1957, 
for  a tonsillectomy  and  adenoidectomy.  A 
previous  examination  at  the  office  revealed  a 
Grade  3 tonsilar  and  adenoid  hypertrophy. 
There  was  a history  of  recurrent  tonsillitis. 
The  physical  examination  was  otherwise 
negative  — temp.  98.6;  pulse  90;  respiration 
25/per  minute;  blood  work  as  follows:  1-8-57: 
i Hgb.-11.5  gms.  79;  WBC-10,200.  Bleeding  time 
I r55”  and  clotting  time  normal. 

! The  child  received  160  mgm  Na.  pentathol 
I.V.  and  was  intubated.  The  relaxation  was 
good  and  a tonsillectomy  and  adenoidectomy 
I performed  without  difficulty  or  remarkable 
! bleeding  under  endoctracheal  anesthesia. 

! After  the  surgical  procedure,  the  respira- 
1 tions  seemed  shallow  and  weak,  but  improved 
I with  bag  breathing  using  0->  and  CO2.  The 
1 endoctracheal  catheter  was  left  in  place  and 
I the  patient  moved  to  the  Recovery  Room. 

I In  the  Recovery  Room  auscultation  of  the 
J heart  revealed  weak  tones  and  very  rapid 
heart  at  approximately  160/per  minute.  The 
; pulse  began  to  disappear  and  for  a few  sec- 
i onds  no  heart  tones  were  heard.  The  patient 

1'  became  very  cyanotic  and  respirations  ceased. 

,1 


When  artificial  respiration  was  adminis- 
tered, a massive  subcutaneous  emphysema 
was  palpable.  The  patient  was  placed  again 
on  bag  breathing  and  1 cc.  coramine  given 
I.M.  The  heart  beat  again  became  audible 


Film  taken  on  1/9/57  (after  surgery)  shows 
massive  pulmonary  emphyema  with  air  in  peri- 
cardial sack,  is  soft  mediostinal  tissue  and  extend- 
ing upward  into  fascial  planes  of  neck. 


SOUTH  DAKOTA 


Film  taken  on  1/10/57  shows  a degree  of  spon- 
taneous clearing.  There  is  a little  air  visible  along 
the  left  upper  cardiac  border  and  in  the  subsutan- 
eous  tissue. 

and  was  shortly  loud  and  strong.  X-rays 
revealed  air  in  the  pericardial  sac,  the  medias- 
tinal and  subcutaneous  tissue. 

The  following  day  the  blood  revealed:  Hgb.~ 
10-68%;  WBC-7,000;  RBC-3,480,000;  PMN-68; 
Lymph-30  Mono. -2.  Urine-occ.  ephth,  sugar- 
neg.,  alb.-neg.  The  patient  was  placed  on  1,000 
mg.  of  Chloromycetin  I.M.  q.  daily. 

Within  two  days  the  pulmonary  em- 
physema had  completely  disappeared  and  the 
chest  x-ray  was  normal. 

This  is  a case  of  pulmonary  emphysema  which 
most  likely  followed  a rupture  of  the  tracheo- 
bronchial tree  following  intubation.  It  is  pre- 
sented only  to  point  out  another  dangerous  ele- 
ment in  the  so-called  “Simple”  tonsillectomy  case. 

REFERENCES 

John  Dorsey,  M.D.,  Christopher  Textbook  of 
Surgery,  1956,  6th  Edition  (Mediastinum). 

William  E.  Adams,  M.D.,  Christopher  Textbook 
of  Surgery,  1956,  6th  Edition  (The  Thoracic  Wall 
and  Pleura). 


INFORMATION  FOR  DOCTORS  CARING 
FOR  VETERANS  ADMINISTRATION  OUT 
PATIENT  CASES 

It  has  been  called  to  our  attention  by  the 
Veterans  Administration  that  the  “Request 
to  Continue  Treatment”  form,  #10-2690C,  in 
many  cases  is  being  returned  to  them  incor- 
rectly filled  out. 

The  spaces  “Period  to  be  Covered”  should 
include  the  dates  that  you  are  requesting 
authorization  for  additional  treatment  in  the 
future,  not  the  dates  of  the  authorization  in 
force  at  the  present  time. 

It  will  be  greatly  appreciated  if  you  will 
call  this  to  the  attention  of  your  office  girl, 
or  whoever  completes  these  forms. 

We  have  also  been  asked  to  remind  you 
that  all  requests  for  emergency  hospitaliza- 
tions must  be  received  by  the  VA  within  72 
hours  of  admittance  to  the  hospital  of  the 
veteran.  Long  Term  office  treatment  author- 
izations do  not  change  hospitalization  regula- 
tions in  any  way. 


ACS  GROUP  HOLDS  MEETING 
IN  HURON 

The  American  College  of  Surgeons  Sixth 
Annual  Meeting  is  being  held  January  18th 
at  the  Marvin  Hughitt  Hotel  in  Huron.  Presi- 
dent is  W.  H.  Saxton,  M.D.,  Huron  and  Secre- 
tary-treasurer is  L.  C.  Askwig,  M.D.,  Pierre. 
The  program  is  scheduled  with  emphasis  on 
Trauma,  featured  speakers  on  the  program  are; 
Roy  E.  Jernstrom,  M.D.,  Rapid  City;  Edward 
J.  McGreevy,  M.D.,  Sioux  Falls;  C.  R.  Sul- 
livan, M.D.,  Rochester,  Minn.;  John  Dough- 
erty, M.D.,  and  C.  B.  McVay,  M.D.,  Yankton; 
Robert  E.  Nelson,  M.D.,  Sioux  Falls;  Phil  S. 
White,  M.D.  and  F.  R.  Williams,  M.D.,  Rapid 
City. 

The  one-day  program  ends  with  a 7:00  P.M. 
banquet  at  the  hotel. 


— 2 — 


THE  DIAGNOSIS  OF  EMOTIONAL 
DISORDERS  IN  CHILDREN 
Jerman  Rose,  M.D.,  Omaha,  Nebraska 


It  is  the  function  of  the  physician  to  help 
human  beings  adapt  successfully  and,  more 
or  less,  comfortably  to  their  environment.  The 
presence  of  noxious  elements  within  the  hu- 
man organism  usually  results  in  discomfort 
and  interference  with  successful  adaptation. 
The  physician  attempts  to  discover  what 
these  elements  are  and  takes  steps  to  remove 
them.  Medical  science  has  been  quite  suc- 
cessful in  helping  us  to  understand  the  sig- 
nals which  indicate  the  presence  of  too  many 
pneumococci  in  the  body.  The  diagnosis  of 
an  uncomplicated  pneumococcal  pneumonia 
is  relatively  simple,  and  the  very  diagnosis 
implies  known  exology  and  the  presence  of  a 
known  pathological  process.  Furthermore, 
we  can  administer  drugs  which  result  in  the 
death  of  the  pneumococci.  Other  substances 
may  be  administered  to  assist  the  body  in  its 
attempts  to  deal  with  the  presence  of  the 
pneumococci. 

If  the  interference  with  adaptation  is  in  the 
realm  of  human  emotions  and  the  noxious 
elements  are  a manifestation  of  disturbances 
in  interpersonal  relationships,  the  matter  is 
not  so  simple.  The  diagnosis  of  emotional 
disorders  in  children  does  not  consist  of  fitting 
the  child  into  the  usual  psychiatric  syn- 
dromes. Hanging  a psychiatric  tag  on  a child 
merely  indicates  that  he  demonstrates  cer- 
tain behavioral  responses  under  certain  cir- 
cumstances which  other  children  will  demon- 

*Presented  at  the  76th  Annual  Meeting  of  the 
South  Dakota  State  Medical  Association,  Tuesday, 
May  21,  1957. 


strate  under  the  same  circumstances  and  that 
these  behavioral  responses  are  different  from 
the  majority  of  children.  To  say  a child  is 
mentally  retarded  implies  nothing  regarding 
the  etiology  of  the  retardation,  nor  does  it 
suggest  methods  of  treatment  which  will  be 
helpful  to  the  child.  Similarly,  describing  a 
child  as  schizophrenic  suggests  no  specific 
disease  process. 

The  child  is  brought  to  the  doctor’s  office 
because  his  parents,  the  teacher  or  the  com- 
munity considers  his  behavior  to  be  unsatis- 
factory. Even  though  the  child  frequently 
senses  that  his  methods  of  dealing  with  his 
world  are  not  totally  satisfying  to  himself  or 
to  others,  he  usually  does  not  ask  to  be 
brought  to  the  doctor.  Complicating  his  situa- 
tion further,  he  encounters  the  doctor  who 
has  a set  of  ideas,  ideals,  and  prejudices 
which  may  make  it  difficult  for  him  to  under- 
stand people  from  different  backgrounds  who 
have  a different  set  of  prejudices.  The  child 
is  fortunate  if  his  physician  has  a knowledge 
of  the  norms  of  the  culture  of  the  child’s  fam- 
ily and  an  awareness  that  his,  the  physician’s 
own  sense  of  values  may  not  be  the  same  as 
those  of  his  patient.  Perhaps  it  is  more  im- 
portant that  the  doctor  has  developed  toler- 
ance for  deviant  behavior  which  differs  from 
his  own  standards  and,  thus,  is  less  likely  to 
make  his  diagnosis  a judgment  rather  than 
an  attempt  to  understand  and  help  an  un- 
happy situation. 

At  the  present  time,  the  historical  and  de- 
velopmental approach  is  the  most  helpful  in 


— 3 — 


SOUTH  DAKOTA 


determining  the  existence  of  an  emotional 
problem.  An  individual  is  born  with  certain 
basic  needs  which  are  common  to  all  man- 
kind. These  are  the  need  for  food,  warmth, 
oxygen,  a sex  object,  sleep  and  the  need  to 
excrete  the  waste  products  of  metabolism. 
In  the  early  years  of  life,  the  presence  of  an- 
other human  being  to  care  for  the  child’s 
needs  is  necessary  if  he  is  to  survive.  The 
manner  in  which  an  individual  has  learned 
to  satisfy  these  needs  will  determine  to  a con- 
siderable extent  how  well  he  adapts  to  his 
society.  Our  society  delegates  the  responsi- 
bility for  molding  these  needs  and  their  phys- 
iological expression  to  the  family.  It  should 
also  be  pointed  out  that  society  considers 
different  items  of  behavior  appropriate  at 
different  stages  of  development.  Social  ade- 
quacy has  been  defined  in  terms  of  behavior 
patterns  commensurate  with  culturally  deter- 
mined age  norms.  If  a three  year  old  walks 
into  his  mother’s  bridge  club  meeting  naked, 
his  behavior  is  not  considered  abnormal; 
whereas,  if  a twelve  year  old  does  the  same 
thing,  we  are  sure  something  is  wrong.  Sev- 
eral books  are  available  which  list  the  appro- 
priate skills  and  behavior  at  various  stages. 
Knowledge  of  these  norms  is  essential  for 
the  accurate  assessment  of  a child’s  behavior. 
In  any  individual  situation  we  should  use 
these  books  as  guides  and  not  consider  them 
to  be  rigidly  delineated  rules  which  are  ap- 
plicable to  all  individuals. 

In  the  course  of  taking  the  usual  medical 
history  consisting  of  presenting  complaint, 
history  of  present  illness,  systemic  review, 
etc.,  one  usually  obtains  leads  which  indicate 
that  the  problem  is  either  primarily  emo- 
tional or  that  unhelpful  emotional  expres- 
sions are  complicating  a physical  illness.  If 
this  appears  to  be  the  case,  particular  atten- 
tion should  be  paid  to  parental  attitudes  re- 
garding the  presenting  complaint.  Whether 
or  not  the  child  was  breast  fed  and  the  age 
at  which  weaning  and  toilet  training  occurred 
are  helpful  in  differential  diagnosis.  Special 
attention  should  be  directed  toward  the 
family  structure.  Consideration  of  the  varia- 
bility of  numbers,  the  patient’s  position  in  the 
family  and  how  his  behavior  compares  with 
that  of  the  other  children  is  of  importance. 
The  presence  of  grandparents  in  the  home 
and  how  much  of  the  child  rearing  responsi- 
bility they  assume,  may  give  an  idea  of  the 


variability  of  demands  which  are  made  on 
the  child  to  conform  to  the  standards  of  dif- 
ferent generations.  Attention  should  also  be 
given  to  how  well  the  parents  are  able  to 
satisfy  their  own  and  each  other’s  needs,  and 
how  well  they  are  able  to  accept  the  respon- 
sibilities of  their  respective  roles  of  husband 
and  wife. 

It  goes  without  saying  that  a thorough 
physical  examination  and  indicated  labora- 
tory work  should  be  done.  It  is  well  not  to 
fall  into  the  trap  of  feeling  that  one  more 
laboratory  examination  may  give  us  an  or- 
ganic etiology  for  a condition  when  we  are 
fairly  certain  the  cause  is  emotional.  Multiple 
and  unnecessary  laboratory  examination  may 
merely  serve  to  intensify  the  discomfort  of 
an  upset  child.  Our  medical  training  makes 
us  fearful  that  we  will  miss  some  organic 
diagnosis,  but  does  not  sensitize  us  to  the  fact 
that  lack  of  recognition  of  an  emotional  dis- 
order may  be  equally  as  damaging. 

Conditions  of  which  the  etiology  is  pri- 
marily organic  may  be  considered  to  be  fo- 
cused around  heredity,  congenital  disorders, 
and  birth  injuries.  Cases  of  proven  heredi- 
tary etiology  are  limited  to  a relatively  small 
group  of  neurological  or  metabolic  conditions 
such  as  Tay-Sachs  disease,  or  phenylketo- 
nuria. 

The  diagnosis  of  Mongolian  Idiocy  and 
other  developmental  defects  of  the  central 
nervous  system  is  usually  relatively  simple. 
The  history  of  birth  injury,  prolonged  anoxia 
at  birth,  etc.,  in  conjunction  with  positive 
neurological  signs,  is  helpful  in  delineating 
certain  conditions  which  seem  to  be  primarily 
due  to  deficiencies  in  the  cerebral  cortex. 

Even  though  the  etiology  of  these  con- 
ditions does  not  seem  to  be  in  the  sphere  of 
interpersonal  relationships,  their  manage- 
ment is  frequently  complicated  by  family  at- 
titudes. Successful  dealing  with  these  family 
attitudes  is  a major  part  of  the  treatment. 

Behavior  patterns  which  seem  to  be  an 
attempt  to  adapt  to  interpersonal  relation- 
ships which  are  either,  not  satisfying,  or,  are 
actually  retarding  the  child’s  emotional 
growth  are  usually  focused  around  one  or 
more  of  the  aforementioned  primary  basic 
needs. 

Colic,  thumbsucking,  biting,  overeating  or 
undereating,  are  symptoms  focused  aroimd 
the  need  for  food.  All  of  these  are  closely  re- 


_4  — 


JANUARY  1958 


lated  to  parent  attitudes  regarding  feeding 
and  food. 

The  manner  in  which  the  excretory  need  is 
dealt  with  by  a family  may  result  in  such 
symptoms  as  enuresis,  encopresis,  excessive 
cleanliness,  excessive  dirtiness,  and  consti- 
pation or  diarrhea. 

Behavior  which,  even  in  childhood,  is  in- 
terpreted by  some  as  sexual  may  express  it- 
self in  peeking,  exhibitionism,  transvestitism, 
and  genital  and  anal  exploration.  This  be- 
havior is  to  be  expected  in  the  preschool 
years  and,  depending  on  how  it  is  dealt  with 
at  this  time,  may  express  itself  in  later  years 
as  perversions. 

Problems  in  sleeping  usually  manifest 
themselves  in  the  parents  feeling  that  the 
child  does  not  sleep  enough  or  else  that  sleep 
is  interrupted.  Arguments  over  bedtime  may 
be  a manifestation  of  a power  struggle  be- 
tween parents  and  child.  Unconscious  fears 
may  express  themselves  in  the  form  of  night- 
mares or  night  terrors. 

While  difficulty  with  authority  and  aggres- 
sive expression  may  manifest  itself  in  the 
preschool  years,  it  does  not  usually  become 
a problem  until  the  school  years.  Even  these 
problems  are  usually  related  to  the  manner  in 
which  the  parents  use  their  authority  in  the 
training  of  the  child. 

Speech  problems  are  frequently  related  to 
fear  or  aggressive  expression  as  if  the  child 
“dare  not  express  himself.” 

Educational  problems  such  as  learning  dis- 
abilities may  be  related  to  a basic  intellec- 
tual lack,  to  the  child’s  fear  of  people  in 
authority,  or  to  lack  of  ability  to  use  his  in- 
tellectual potential  because  of  anxieties. 

As  a part  of  the  diagnostic  procedure,  the 
child  should  be  interviewed  alone.  The  be- 
havior of  the  child  and  the  parent  at  the  time 
this  separation  is  suggested,  is  a significant 
part  of  the  diagnosis  in  that  it  may  give 
clues  regarding  parental  overprotection  or 
other  dependency-independency  conflict.  The 
manner  in  which  the  child  relates  to  the  doc- 
tor alone  is  of  great  importance  in  determin- 
ing how  the  child  relates  to  relative  strangers 
or  people  in  authority,  or  how  rapidly  he  can 
differentiate  a circumstance  in  which  he  may 
be  hurt  by  a needle  and  a circumstance  in 
which  the  doctor  “just  wants  to  talk.”  When 
dealing  with  small  children,  it  may  be  wise  to 
have  a supply  of  play  materials  available. 


The  use  of  these  materials  is  a specialized 
technique  which  may  be  learned  readily  if 
the  physician  is  aware  of  the  fact  that  chil- 
dren express  the  way  they  feel  about  them- 
selves and  the  world  around  them  through 
the  medium  of  play.  Play  materials  should 
include  paper  and  pencil,  crayons,  modeling 
clay,  toy  automobiles,  airplanes,  and  cap  pis- 
tols. A complete  family  of  dolls  and  a doll 
house  are  also  helpful.  For  both  younger  and 
older  children,  games  such  as  checkers  may 
be  helpful  to  determine  competitiveness  and 
the  child’s  capacity  to  relate. 

With  a little  patience,  children  of  eight  or 
nine  or  older  may  be  interviewed  in  the  ques- 
tion and  answer  method.  It  is  well  to  realize 
that  the  child  is  a reasonable  human  being 
who  is  quite  capable  of  understanding  you 
if  you  “speak  his  language.”  As  a matter  of 
fact  he  may  understand  our  feelings  better 
than  we  understand  his.  Taking  a history 
from  him  is  more  for  the  purpose  of  taking 
note  of  his  emotional  responses  and  his  feel- 
ings about  various  aspects  of  his  life  than  it 
is  to  find  out  what  has  really  happened  to 
him.  If  the  child  is  so  anxious  that  he  cannot 
participate  in  the  interview  situation,  there 
is  no  need  to  vigorously  attempt  to  get  him 
to  talk,  or  “to  get  his  side  of  the  story.”  In 
such  cases,  observation  of  his  responses  and 
recognition  of  his  fear  is  sufficient.  Topics 
to  be  discussed  are: 

1.  What  does  the  child  believe  is  the  rea- 
son for  being  brought  to  see  you?  For 
example,  does  he  see  you  as  one  who 
will  punish  him? 

2.  History  of  present  illness  as  the  child 
sees  it.  How  long  has  he  had  difficul- 
ties? What  does  he  believe  is  the  cause 
of  his  difficulty  and  what  has  been 
done  about  it? 

3.  How  does  the  child  feel  about  himself? 
What  kind  of  a guy  are  you  do  you 
feel  you  are  pretty  nice  or  pretty  bad? 
Children  frequently  volunteer  that  they 
feel  they  are  bad  or  good. 

4.  How  does  he  view  himself  in  relation- 
ship to  his  mother  and  father  and  to  his 
siblings?  Who  is  his  mother’s  favorite? 
His  father’s  favorite?  Does  he  seem 
rivalrous  with  his  siblings  and  is  he 
more  rivalrous  with  siblings  of  the  same 

(Continued  on  Page  17) 


— 5 — 


SUMMARY  OF  MEDICARE 
IN  SOUTH  DAKOTA* 
Arthur  A.  Lampert,  M.D. 


SOUTH  DAKOTA 


Mr.  Koenig  has  discussed  Wisconsins  Med- 
icare and  Dr.  Offerman  has  covered  Ne- 
braska’s. Dr.  Offerman  also  gave  some  of 
the  reasons  for  the  institution  of  Medicare. 
Each  has  cited  some  of  their  problems  and 
made  some  suggestions. 

I propose  to  review  South  Dakota’s  opera- 
tion briefly.  And  if  time  permits  would  like 
to  broach  on  the  boarder  intangibles  of  Med- 
icare bringing  into  focus  some  basic  questions 
which  I believe  we  as  a profession  must  face 
and  answer  before  I reach  age  50.  That  gives 
us  the  rest  of  this  session  of  Congress  and  one 
more. 

Slide  I 

Cliams  Pd.  Adm.  Cost  % Adm.  Cost 
$99,291.17  $3,846.50  3.87% 

Adm.  cost  includes  all  cost  of  establishing 
program 

Present  rate  of  operation  2.5% 

Total  claims  pd.  through  Oct.  ’57 
1304 

Present  cost  formula  per  claim 
$2.02 


Slide  II 


No. 

Total 

Cost 

Fee 

Item 

Cases 

Cost 

/Case 

Allowed 

Obstet. 

428 

45,531 

106 

150 

Caes. 

8 

1,678 

209 

200 

Med.  care 

318 

14,260 

45 

Hernia 

25 

3,570 

143 

150-175 

Appen. 

14 

2,197 

156 

165 

Slide  III 

No. 

Total 

Cost 

Fee 

Item 

Cases 

Cost 

/Case 

Allowed 

Hemmor. 

5 

458 

91 

125 

Fract. 

17 

1384 

81 

Indiv. 

Ovary 
& Tube 

8 

1793 

224 

Consid. 

Hyster. 

5 

1302 

260 

175 

300 

BH  Area 

70.4% 

All 

other  29.6% 

Slide  IV 

1956  1957 

Ellsworth 

OB  60/month  30/month 

Dependent 

Hospitalized  Down  20% 

OP  Unable  to  see  all.  See  all.  No  rush. 
Army  Opinion:  Satisfied.  Do  better  med- 
icine. 

Profession  Opinion:  Satis.  Few  fee  dis- 
putes. 

* Presented  at  the  North  Central  Medical  Confer- 
ence, Minneapolis,  Nov.  24,  1957. 


Now  — I propose  to  assume  the  typical 
physical  position  the  Medical  Profession  has 
assumed  on  so  many  occasions  recently  — 
that  of  my  foot  in  my  mouth.  What  are  the 
broad  implications  of  Medicare?  Does  it  rep- 
resent socialized  medicine?  Will  it  expand  to 
include  veterans  with  service  connected  dis- 
abilities, veterans  without  service  connected 
disabilities,  the  dependents  of  either  or  both, 
pensioners,  Federal  employees,  certain  union? 
Will  it  set  fees  for  all  care?  Will  we  lose  the 
right  of  free  choice  both  by  the  physicians 
and  by  the  patient,  will  we  eventually  be 
told  how  and  when  to  practice?  Will  all  in- 
dividual initiative  be  lost? 

Slide  V 

1.  Is  Medicare  Socialized  or  Nationalized 
Medicine? 

2.  Will  it  expand? 

3.  Will  it  set  fees  on  all  cases? 

4.  Will  both  patients  and  Doctors  lose  free 
choice? 

5.  Will  we  be  told  how,  when  and  where 
to  practice? 

6.  Will  individual  initiative  be  impaired? 

To  answer  some  of  the  questions  we  have 
asked,  I believe  we  must  establish  some  back- 
ground and  here  I will  hurry. 

First,  I would  like  to  define  that  which  is 
Socialism  to  me.  Socialism  in  both  a phil- 
osophy and  a movement.  Reduced  to  its 
simplest  practical  expression,  it  means  the 
complete  discarding  of  the  institution  of 
private  property  by  transforming  it  to  public 
property;  and  the  division  of  the  resultant 
public  income  equally  and  indiscriminately 
among  the  entire  population.  In  Socialism, 
private  property  is  a curse  and  income  dis- 
tribution is  the  first  consideration. 

Capitalism,  which  is  about  the  opposite  of 
Socialism,  means  the  establishment  of  private 
or  real  property  to  its  utmost  physical  extent, 
then  leaving  the  distribution  of  income  to 
take  care  of  itself.  In  Capitalism,  private 
property  is  cardinal,  income  distribution  is 
incidental. 

Certainly  in  our  last  30  or  40  years  in  this 
country,  we  have  been  in  an  economic  evolu- 
tion in  which  the  key  factor  is  social  adjust- 


_6  — 


JANUARY  1958 


merit.  Nowdays,  the  state  feels  under  obliga- 
tion to  provide  work  for  all  and  public  assist- 
ance for  many. 

Socialism  never  arises  in  the  earlier  phases 
of  Capitalism.  In  the  earlier  phase  of  Capital- 
ism, land  in  unlimited  amounts  is  available 
and  the  means  of  private  income  are  subject 
only  to  the  influences  of  ambition  and  ability. 
Luck  and  hard  luck  plays  some  factor  but 
minimal.  This  phase  dosen’t  last  long  under 
modern  conditions. 

The  more  favorable  means  of  income  soon 
become  privately  owned.  The  late  comers  are 
then  obligated  to  hire  space  and  equipment 
at  a price  from  its  owners.  The  former,  then 
are  a renter  class  enjoying  unearned  income, 
according  to  the  Socialists  theories,  which  in- 
creases as  the  population  increases.  Soon,  an 
‘owner’  class  develops.  Those  successfully 
hiring  land  equipment  become  a manager 
class  and  all  others  live  as  hired  artisans  or 
laborers  at  a weekly  wage.  Society  then  has 
an  owner  class,  a middle  or  managing  class 
and  a large  wage  proletariat.  The  owner 
group  are  parasitic  and  as  they  become  richer 
luxuries  are  produced  by  hired  help  who 
vote  as  their  source  of  bread  and  butter  dic- 
tates. Competition  develops  and  soon  the 
country  is  in  alternating  overproduction  and 
period  of  bad  trade.  In  other  words,  the 
‘boom  or  bust’  we  have  experienced  here  de- 
velops. When  wages  fall  below  the  point  of 
living  expenses  the  unemployed  have  no 
means  of  subsistence  except  public  or  relief 
rolls. 

In  this  phase  of  Capitalism,  Socialism  rears 
its  head.  Governments  are  forced  to  inter- 
vene and  readjust  distribution  of  income  to 
some  extent  by  confiscating  larger  and  larger 
percentages  of  income  derived  from  private 
property.  It  then  applies  the  proceeds  to  such 
things  as  unemployment  insurance,  social 
security,  health  benefits  as  in  Medicare,  soil- 
bank,  etc. 

This  confiscation  of  private  property  and 
private  income  for  public  purposes  without 
any  pretense  of  compensation  which  is  now 
proceeding  on  a scale  inconceivable  25  years 
ago  has  destroyed  the  integrity  of  private 
property  and  inheritance.  To  the  masses,  the 
success  with  which  confiscated  capital  has 
been  applied  to  communal  programs  contras- 
ted with  the  failure  of  capitalist  controlled 
relief  of  improverishment  has  shaken  the 


masses  belief  that  private  management  is  al- 
ways better  than  public  management. 

This  change  in  public  opinion  has  already 
deeply  penetrated  the  worker  and  the  aver- 
age employer.  Loss  of  faith  in  Capitalism 
has  been  greater  than  growth  of  faith  in  So- 
cialism. We,  in  this  room,  I feel  sure  recog- 
nize social  problems  exist.  Yet,  we  have  a) 
no  grasp  of  constructive  solutions,  b)  loath 
taxation  as  such,  c)  dislike  being  governed 
at  all,  d)  dread  and  resent  any  extension  of 
official  interference  as  an  encroachment  on 
private  liberty  and  personal  liberty. 

Our  lawmakers  are  no  smarter  than  we. 
They  feel  the  same  way.  They  won’t  confront 
you  as  a voter  with  the  truth  of  the  solutions 
of  our  problems  because  it  means  increased 
taxation  and  subsequently  the  loss  of  their 
political  job. 

In  my  mind,  trade  unionism  is  a form  of 
Capitalism.  The  labor  market  is  cornered  by 
a few  and  the  services  of  the  laborer  are  in 
a manner  sold  to  the  highest  bidder  giving 
that  bidder  the  least  possible  in  return. 

One  of  the  mistakes  made  by  Capitalism 
so  far  is  that  it  has  not  educated  the  masses 
that  not  only  do  they  have  an  obligation  to 
work  to  provide  for  those  less  furtunate,  but 
that  they  each  have  an  obligation  to  labor 
for  society  according  to  their  own  powers. 
Over  a hundred  years  ago,  one  of  the  first 
instigators  of  Socialistic  movements  stated 
that  it  was  the  duty  of  the  state  to  plan  and 
organize  the  use  of  the  means  of  production 
such  that  each  individual  in  the  state  had 
more  than  it  took  to  exist.  Could  not  that 
also  be  used  as  a statement  for  the  duty  of  a 
Capitalistic  state.  Compulsory  national  ser- 
vice is  essential  to  Socialism. 

It  is  a historic  fact  that  Capitalism  which 
builds  the  greatest  civilizations  on  earth  also 
wrecks  them  if  persisted  in  beyond  a certain 
point.  It  is  easy  to  demonstrate  on  paper  that 
civilization  can  be  saved  and  developed  by 
discarding  Capitalism  and  changing  the  pri- 
vate property  profiteering  state  into  the  com- 
mon property  distributive  state.  The  moment 
for  change  has  come  again  and  again  but 
never  been  found.  Capitalistic  nations  have 
never  educated  the  masses,  have  never  pro- 
duced the  brains  to  solve  our  social  problem 
and  not  wreck  our  productivity.  Common- 
wealths have  hitherto  been  beyond  the  civic 


_7__ 


SOUTH  DAKOTA 


capacity  of  mankind.  But  there  is  always  the 
possibility  that  mankind  will  this  time 
weather  the  storm  by  which  old  civilizations 
have  been  wrecked.  It  is  this  possibility 
which  gives  intense  interest  to  our  present 
times. 

Now,  to  go  back  to  our  slide.  Question  1. 
Is  Medicare  socialized  or  nationalized  med- 
icine? Certainly.  It  is  a form  of  medicine 
paid  for  by  the  state  and  produced  for  the 
state  for  a certain  amount.  It  was  probably 
the  best  we  could  do  under  the  circumstances 
and  could  have  been  a lot  worse.  Whether  or 
not  a series  of  insurance  plans  would  have 
been  better  is  a question  which  could  be 
argued  from  now  until  dooms  day.  I per- 
sonally doubt  that  a series  of  insurance  plans 
could  have  been  instituted  as  rapidly  or  as 
efficiently  as  Medicare  was,  primarily 
through  cooperation  between  government 
and  the  profession  of  medicine. 

Question  2.  Will  it  expand?  Certainly  it  is 
up  to  us  as  doctors  to  attempt  to  prevent  its 
expansion.  Already  bills  have  been  intro- 
duced into  Congress  notably  by  some  gentle- 
man from  Rhode  Island  (Borland  - HB  9467) 
and  some  others  from  Louisiana  to  expand 
this  type  of  Medicare,  this  type  of  medical 
care  to  include  some  old  age  pensioners  and 
even  to  include  some  veterans.  It  seems  pos- 
sible to  me  that  Mr.  Reuther  of  Michigan 
would  look  with  favor  on  the  Michigan  State 
Medical  Society  if  they  would  talk  an  ex- 
panded type  Medicare  plan  to  him  for  his 
unions. 

Question  3.  Will  it  set  fees  on  all  cases?  My 

belief  here  is  this.  As  doctors,  I believe  we 
are  entitled  to  a fair  fee  for  a service.  I do 
not  believe  that  we  are  entitled  in  this  day 
and  age  to  charge  strictly  according  to  a 
man’s  income.  Fee  schedules  or  schedules  of 
allowances  are  more  common  than  they  are 
uncommon,  and  I believe  Medicare  is  just 
one  of  the  many  things  which  will  tend  to 
place  our  services  within  limits.  As  an  in- 
dividual doctor,  if  I’m  given  what  I consider 


a maximum  fair  fee  for  any  one  procedure,  I 
still  feel  that  I am  deciding  what  I’m  going 
to  charge  the  patient  for  the  reason  that  I 
know  all  people  cannot  afford  to  pay  in  ma- 
terial things,  namely  money,  for  that  which 
is  best.  Our  profession  differs  from  any  other 
in  that  we  have  just  one  class  of  product  and 
that  is  the  best  that  we  know  how  to  produce. 
If  we  didn’t  wish  to  give  that  type  of  product, 
we  wouldn’t  be  physicians.  We  cannot  each 
time  expect  the  maximum  fee. 

Question  4.  Will  both  patients  and  doctors 
lose  their  free  choice?  To  me,  that  phase  of 
Medicare  which  preserves  the  right  of  the 
patient  to  choose  his  doctor  and  the  right  of 
the  doctor  to  choose  his  patient,  is  one  of  the 
features  which  was  done  almost  without  any 
error.  I believe  it  has  established  a pattern 
which  will  make  it  easier  for  us  to  preserve 
that  same  right  under  many  of  the  circum- 
stances in  which  that  right  is  threatened  at 
the  present  time. 

Question  5.  Will  we  be  told  how,  when  and 
where  to  practice?  Not  in  the  forseeable 
future. 

Question  6.  Will  individual  initiative  be 
impaired?  Here,  I believe  that  one  of  the 
niost  serious  diseases  of  America  today  is 
not  polio  or  heart  disease,  or  cancer,  but  is 
the  disease  of  complacency.  There  are  en- 
tirely too  many  people  who  believe  that  they 
are  entitled  to  the  Garden  of  Eden  regardless 
of  their  efforts.  We  have  those  men  in  med- 
icine just  as  we  have  them  as  patients  and 
there  will  be  those  among-  us  who  take  the 
course  of  least  resistance.  For  those  of  us 
who  still  are  more  or  less  rugged  individual- 
ists, and  I believe  most  doctors  are  still  in  the 
tobacco  chewing  catagory  as  far  as  their  own 
thoughts  are  concerned  — I can  see  no  danger 
of  the  loss  of  initiative.  I can  see  no  danger 
that  those  of  us  who  want  to  work  and  to 
attempt  to  accumulate  something  in  spite  of 
high  taxes  will  have  anything  limiting  us  ex- 
cept our  physical  capacity  for  work. 


JANUARY  1958 


CONTRIBUTORS  TO 
AMEF  IN  1957 
DISTRICT  I 

R.  AVOTINS,  M.D. 

J.  N.  BERBOS,  M.D. 

R.  BERZINS,  M.D. 

P.  G.  BUNKER,  M.D. 

J.  L.  CALENE,  M.D. 

K.  P.  CURTIS,  M.D. 

G.  MC  INTOSH,  M.D. 

R.  G.  MAYER,  M.D. 

P.  S.  NELSON,  M.D. 

V.  NORGELLO,  M.D. 

R.  K.  RANK,  M.D. 

E.  A.  RUDOLPH,  M.D. 

G.  H.  STEELE,  M.D. 

P.  R.  SCALLIN,  M.D. 

K.  ZVEJNICKS,  M.D. 

AVERAGE  $40.07 
DISTRICT  II 

S.  W.  ALLEN,  M.D. 

J.  W.  ARGABRITE,  M.D. 
R.  AUSKAPS,  M.D. 

H.  R.  BROWN,  M.D. 

R.  M.  KILGARD,  M.D. 

M.  W.  LARSON,  M.D. 

V.  C.  MARR,  M.D. 

R.  T.  MAXWELL,  M.D. 

M.  C.  ROUSSEAU,  M.D. 

C.  R.  STOLTZ,  M.D. 

J.  J.  STRANSKY,  M.D. 

AVERAGE  $32.27 
DISTRICT  III 

D.  S.  BAUGHMAN,  M.D. 

S.  FRIFELD,  M.D. 

R.  H.  HENRY,  M.D. 

M.  HUREWITZ,  M.D. 

R.  L.  LILIARD,  M.D. 

B.  T.  OTEY,  M.D. 

A.  P.  PEEKE,  M.D. 

C.  S.  ROBERTS,  JR.,  M.D. 

D.  L.  SCHELLER,  M.D. 

G.  E.  WHITSON,  M.D. 

H.  R.  WOLD,  M.D. 

AVERAGE  $44.44 
DISTRICT  IV 

E.  H.  COLLINS,  M.D. 

E.  FLYNN,  M.D. 

A.  HOHTY,  M.D. 

R.  C.  JAHRAUS,  M.D. 

J.  B.  JANIS,  M.D. 

G.  J.  MANGULIS,  M.D. 

M.  M.  MORRISSEY,  M.D. 
R.  ORGUSAAR,  M.D. 


C.  L.  SWANSON,  M.D. 

T.  F.  RIGGS,  M.D. 

S.  B.  SIMON,  M.D. 

E.  URBANYI,  M.D. 

AVERAGE  $32.66 
DISTRICT  V 

G.  R.  BELL,  M.D. 

R.  A.  BUCHANAN,  M.D. 

R.  DEAN,  M.D. 

J.  C.  HAGIN,  M.D. 

E.  A.  HOFER,  M.D. 

R.  D.  HURA,  M.D. 

HURON  CLINIC 

T.  MCMANUS,  M.D. 

M.  W.  PANGBURN,  M.D. 

P.  TSCHETTER 

AVERAGE  $63.00 
DISTRICT  VI 

C.  F.  BINDER,  M.D. 

P.  P.  BROGDON,  M.D. 

F.  D.  GILLIS,  M.D. 

L.  W.  HOLLAND,  M.D. 

J.  H.  LLOYD,  M.D. 

D.  R.  MABEE,  M.D. 

0.  J.  MABEE,  M.D. 

J.  P.  MC  CANN,  M.D. 

W.  S.  PEIPER,  M.D. 

F.  J.  TOBIN,  M.D. 

V.  R.  VONBURG,  M.D. 

AVERAGE  $28.00 
DISTRICT  VII 

T.  R.  ANDERSON,  M.D. 

W.  ANDERSON,  M.D. 

T.  A.  ANGELOS,  M.D. 

S.  F.  BECKER,  M.D. 

P.  R.  BILLINGSLEY,M.D. 

K.  R.  BURNS,  M.D. 

B.  CHURCH,  M.D. 

WM.  DONAHOE,  M.D. 

1.  D.  EIRENBERG,  M.D. 

D.  L.  ENSBERG,  M.D. 

R.  G.  FISK,  M.D. 

R.  R.  GIEBINK,  M.D. 

J.  H.  HOSKINS,  M.D. 

W.  L.  JONES,  M.D. 

C.  E.  KEMPER,  M.D. 

L.  KING,  M.D. 

H.  O.  KITTELSON,  M.D. 

E.  J.  LIETZKE,  M.D. 

R.  E.  NELSON,  M.D. 

P.  C.  REAGAN,  M.D. 

G.  SMITH,  M.D. 

C.  A.  STERN,  M.D. 

G.  E.  VAN  DEMARK,  M.D. 


R.  E.  VAN  DEMARK,  M.D. 
P.  VAN  LIER,  M.D. 

H.  P.  VOLIN,  M.D. 

V.  V.  VOLIN,  M.D. 

N.  E.  WESSMAN,  M.D. 

AVERAGE  $54.32 
DISTRICT  VIII 

F.  J.  ABTS,  M.D. 

D.  J.  GLOOD,  M.D. 

W.  W.  GROVER,  M.D. 

F.  W.  HAAS,  M.D. 

J.  A.  HOLF,  M.D. 

C.  F.  JOHNSON,  M.D. 

F.  O.  KELSEY,  M.D. 

M.  B.  LYSO,  M.D. 

C.  B.  MCVAY,  M.D. 

R.  S.  MONK,  M.D. 

T.  P.  PRICE,  M.D. 

B.  RANNEY,  M.D. 

D.  B.  REANEY,  M.D. 

A.  REDING,  M.D. 

E.  RIESBERG,  M.D. 

H.  RIESBERG,  M.D. 

T.  H.  SATTLER,  M.D. 

W.  F.  STANAGE,  M.D. 

R.  F.  THOMPSON,  M.D. 

T.  H.  WILLCOCKSON,  M.D. 

AVERAGE  $29.00 
DISTRICT  IX 
J.  D.  BAILEY,  M.D. 

R.  A.  BOYCE,  M.D. 

J.  M.  BUTLER,  M.D. 
BLACK  HILLS  DISTRICT 
MEDICAL  SOCIETY 
(MEMORIALS) 

B.  S.  CLARK,  M.D. 

J.  N.  HAMM,  M.D. 

F.  S.  HOWE,  M.D. 

R.  E.  JERNSTROM,  M.D. 

P.  KOREN,  M.D. 

A.  A.  LAMPERT,  M.D. 

J.  E.  MATTOX,  M.D. 

H.  B.  MUNSON,  M.D. 

A.  J.  SAXTON,  M.D. 

F.  U.  SEBRING,  M.D. 

A.  M.  SEMONES,  M.D. 

S.  SHERRILL,  M.D. 

J.  C.  SMILEY,  M.D. 

M.  L.  SPAIN,  M.D. 

G.  F.  WOOD,  M.D. 

J.  V.  YACKLEY,  M.D. 

AVERAGE  $42.00 
DISTRICT  10 
F.  J.  CLARK,  M.D. 


— 9 — 


SOUTH  DAKOTA 


R.  H.  HAYES,  M.D. 

P.  LAKSTIGALA,  M.D. 

R.  W.  ROESEL,  M.D. 

J.  E.  STUDENBERG,  M.D. 
O.  ZEIDAKS,  M.D. 

AVERAGE  $97.50 
DISTRICT  11 
J.  H.  LOWE,  M.D. 

AVERAGE  $250.00 
DISTRICT  12 
R.  JARAVS,,  M.D. 

AVERAGE  $5.00 
CONTRIBUTIONS  TO 
AMEF  FROM  OUT-OF- 
STATE  PHYSICIANS 
M.  C.  BEIL,  M.D. 

R.  S.  BOLIN,  M.D. 

T.  F.  HEGERT,  M.D. 

E.  G.  HESTER,  M.D. 

A.  J.  PRESTO,  M.D. 

G.  B.  ROGET,  M.D. 

H.  F.  SCHUNKNECKT,  M.D. 
M.  E.  SHERMAN,  M.D. 

D.  W.  SHUSTER,  M.D. 

A.  F.  STERLING,  M.D. 

WM.  W.  STEVENSON,  M.D 
D.  N.  TWEEDLE,  M.D. 

AVERAGE  $44.16 
Groups  From  S.  D.  Huron 
District  Medical  Society  S.  D. 
Academy  of  Ophthalmology 
and  Otolaryngology 

AVERAGE  $125.00 


FROM  THE  GRAY 
FLANNELS 

Detailing  is  a recognized 
part  of  drug  distribution  in 
every  part  of  the  world 
where  manufacturing  phar- 
macy exists,  the  general 
manager  of  a New  York 
pharmaceutical  firm  declared 
here  today. 

Manufacturer’s  representa- 
tives help  speed  the  distri- 
bution of  ethical  drugs  by 
performing  at  least  10  val- 
uable services  for  dispensing 
pharmacists,  Arthur  C.  Eme- 
lin told  a meeting  of  the 
Fourth  Pan-American  Con- 
gress of  Pharmacy  and  Bio- 
chemistry. 


Mr.  Emelin  addressed  the 
section  on  pharmaceutical 
economics  in  the  Hotel  May- 
flower. He  heads  the  J.  B. 
Roerig  and  Company,  di- 
vision of  Chas.  Pfizer  & Co., 
Inc.,  in  New  York. 

While  primarily  salesmen, 
Mr.  Emelin  said,  detail  men 
also  post  pharmacists  on 
trends  in  prescription  writ- 
ing conduct  inventories  for 
them  and  advice  on  prescrip- 
tion item  promotions. 

They  help  out  in  emer- 
gencies “even  at  night  and 
on  Sundays”  and  explain 
their  products  to  store  per- 
sonnel, Emelin  said.  He  enu- 
merated other  valuable  ser- 
vices detail  men  can  perform 
for  pharmacists. 


The  selection  of  John  E. 
McKeen,  president  of  Chas. 
Pfizer  & Co.,  Inc.,  as  one  of 
the  country’s  fifty  foremost 
business  leaders  was  an- 
nounced this  week  by  Forbes 
Magazine.  Medallions  em- 
blematic of  the  achievements 
and  leadership  of  those 
chosen  for  the  honor  were 
presented  to  each  executive 
by  Bruce  C.  Forbes,  presi- 
dent, Forbes,  Inc.,  at  a ban- 
quet held  in  the  grand  ball- 
room of  the  Waldorf-Astoria 
Hotel,  New  York,  on  Novem- 
ber 6. 

The  medals  were  named 
for  Mexico’s  late  Dr.  Miguel 
Jimenez,  who  is  famed  for 
his  clinical  work  in  liver  di- 
seases. 


Falvin,  a complete  hema- 
tinic  containing  a new  intrin- 
sic factor  which  augments 
the  absorption  of  vitamin 
Bi2,  above  normal  levels,  has 
been  introduced  by  Lederle 


Laboratories  Division,  Amer- 
ican Cyanamid  Company. 
The  new  Autrinic  intrinsic 
factor  aids  the  absorption  of 
Bi2  through  the  gastro-in- 
testinal  mucosal  barrier, 
solving  a problem  which  has 
limited  the  usefulness  of 
previously  available  oral 
hematinics,  which  inhibited 
Bi2  absorption. 

Falvin  is  indicated  for  ma- 
croytic  and  microcytic  an- 
emias and  the  treatment  of 
marginal  anemias  and  the  B12 
deficiency  states  which  may 
predispose  a patient  to  en- 
emia.  Since  it  restores  op- 
tinal  Bi2  serum  levels,  Falvin 
is  effective  for  maintenance 
therapy,  prophylaxis  and  on 
relapse. 


Fifty  thousand  medical 
doctors  locate  din  areas  being 
served  by  educational  tele- 
vision stations  are  receiving 
from  Sobering  Corporation 
an  informational  brochure 
aimed  to  increase  interest  in 
“World  of  Medicine,”  a series 
of  emidcal  programs. 

The  “World  of  Medicine” 
series  of  13  half  hour  kine- 
scopes, was  produced  by  the 
Organization  for  the  National 
Support  of  Educational  Tele-  ' 
vision  (ONSET)  under  a pub-  ^ 
lie  service  grant  from  Scher-  i 
ing  Corporation.  i 

Early  response  from  edu-  j | 
cational  tlevision  stations  in-  ? 
dicates  enthusiastic  accept- » 
ance  of  the  series  as  a public  ^ 
service  venture  on  behalf  of  J 
the  medical  professions.  The  ij 
programs  have  earned  the 
endorsement  of  medical  so- ' 
cieties  and  many  medical  col- 
leges. The  series  represent  a 
pioneering  effort  on  the  part 
of  industry  to  aid  educational 
television. 

i 


— 10  — 


JANUARY  1958 


REPORT  ON  ACTIONS  OF  THE  HOUSE 
OF  DELEGATES 

AMERICAN  MEDICAL  ASSOCIATION 
ELEVENTH  CLINICAL  MEETING 
DEC.  3-6.  1957 
PHILADELPHIA 


Fluoridation  of  public  water  supplies,  free 
choice  of  physician,  the  Heller  Report  on  or- 
ganization of  the  American  Medical  Associa- 
tion, the  Forand  Bill  providing  hospital  and 
surgical  benefits  for  Social  Security  bene- 
ficiaries, guides  for  occupational  health  pro- 
grams covering  hospital  employees,  distri- 
bution of  Asian  Influenza  vaccine  and  guides 
for  the  medical  rating  of  physical  impair- 
ment were  among  the  variety  of  subjects 
acted  upon  by  the  House  of  Delegates  at  the 
American  Medical  Association’s  Eleventh 
Clinical  Meeting  held  Dec.  3-6  in  Philadel- 
phia. 

Dr.  Cecil  W.  Clark  of  Cameron,  Louisiana, 
was  named  1957  General  Practitioner  of  the 
Year  after  his  selection  by  a special  commit- 
tee of  the  Board  of  Trustees  for  outstanding 
community  service.  Dr.  Clark,  33-year-old 
country  doctor  who  was  a medical  hero  dur- 
ing Hurricane  Audrey  last  June,  was  present 
at  the  meeting  to  receive  the  gold  medal 
which  goes  with  the  annual  award. 

Speaking  at  the  opening  session  on  Tues- 
day, Dr.  David  B.  Allman  of  Atlantic  City, 
A.M.A.  President,  called  for  “more  freedom, 
not  less,  in  America  and  in  the  medical  pro- 
fession.” Dr.  Allman  urged  the  delegates  to 
embark  on  local  action  campaigns  to  enlist 
full  community  support  in  opposition  to  the 
Forand  Bill,  a pending  Congressional  pro- 
posal which  would  provide  hospital  and  sur- 
gical benefits  for  persons  who  are  receiving 
or  are  eligible  for  Social  Security  retirement 
and  survivorship  payments.  The  Forand  Bill, 
he  said,  is  “cut  from  the  same  cloth”  as  na- 
tional compulsory  health  insurance  and 
“enamates  from  the  same  minds.” 

Total  registration  at  the  end  of  the  third 
day  of  the  meeting,  with  half  a day  still  to 
go,  had  reached  5,375,  including  2,562  phys- 
ician members. 

Fluoridation  of  Water 

In  settling  the  most  controversial  issue  at 
the  Philadelphia  meeting,  the  House  of  Dele- 
gates approved  a joint  report  of  the  Council 


on  Drugs  and  the  Council  on  Foods  and  Nu- 
trition which  endorsed  the  fluoridation  of 
public  water  supplies  as  a safe  and  practical 
method  of  reducing  the  incidence  of  dental 
caries  during  childhood.  The  27-page  report 
on  the  study  which  was  directed  by  the 
House  at  the  Seattle  Clinical  Meeting  one 
year  ago  contained  these  conclusions: 

“1.  Fluoridation  of  public  water  supplies  so 
as  to  provide  the  approximate  equivalent  of 
1 ppm  of  fluorine  in  drinking  water  has  been 
established  as  a method  for  reducing  dental 
caries  in  children  up  to  10  years  of  age.  In 
localities  with  warm  climates,  or  where  for 
other  reasons  the  ingestion  of  water  or  other 
sources  of  considerable  fluorine  content  is 
high,  a lower  concentration  of  fluoride  is 
advisable.  On  the  basis  of  the  available  evi- 
dence, it  appears  that  this  method  decreases 
the  incidence  of  caries  during  childhood.  The 
evidence  from  Colorado  Springs  indicates  as 
well  a reduction  in  the  rate  of  dental  carries 
up  to  at  least  44  years  of  age. 

“2.  No  evidence  has  been  found  since  the 
1951  statement  by  the  Councils  to  prove  that 
continuous  ingestion  of  water  containing  the 
equivalent  of  approximately  1 ppm  of  fluor- 
ine for  long  periods  by  large  segments  of  the 
population  is  harmful  to  the  general  health. 
Mottling  of  the  tooth  enamel  (dental  fluor- 
osis) associated  with  this  level  of  fluoridation 
is  minimal.  The  importance  of  this  mottling 
is  outweighed  by  the  caries-inhibiting  effect 
of  the  fluoride. 

“3.  Fluoridation  of  public  water  supplies 
should  be  regarded  as  a prophylactic  measure 
for  reducing  tooth  decay  at  the  community 
level  and  is  applicable  where  the  water 
supply  contains  less  than  the  equivalent  of 
1 ppm  of  fluorine.” 

Free  Choice  of  Physician 

Acting  on  the  issue  of  free  choice  in  rela- 
tion to  contract  practice,  the  House  passed  a 
resolution  which  reaffirmed  approval  of  pre- 
vious interpretations  of  the  Principles  of 
Medical  Ethics  by  the  Association’s  Judicial 


— 11  — 


SOUTH  DAKOTA 


Council  and  directed  that  they  be  called  to 
the  attention  of  all  constituent  associations 
and  component  societies.  One  Council  opin- 
ion, issued  in  1927  and  reaffirmed  in  Phila- 
delphia, stated  that  the  contract  practice  of 
medicine  would  be  determined  to  be  un- 
ethical if  “a  reasonable  degree  of  free  choice 
of  physician  is  denied  those  cared  for  in  a 
community  where  other  competent  physicians 
are  readily  available.”  The  resolution  also 
cited  a Council  opinion,  published  in  the  Oc- 
tober 19,  1957,  issue  of  The  Journal  of  the 
A.M.A.,  which  stated  that  the  basic  ethical 
concepts  in  both  the  1955  and  1957  editions 
of  the  Principles  of  Medical  Ethics  are  iden- 
tical in  spite  of  changes  in  format  and  word- 
ing. This  opinion  added  that  “no  opinion  or 
report  of  the  Council  interpreting  these  basic 
principles  which  were  in  effect  at  the  time 
of  the  revision  has  been  rescinded  by  the 
adoption  of  the  1957  principles.” 

The  1927  Council  report  also  pointed  out 
that  “there  are  many  conditions  under  which 
contract  practice  is  not  only  legitimate  and 
ethical,  but  in  fact  the  only  way  in  which 
competent  medical  service  can  be  provided.” 
Judgment  of  whether  or  not  a contract  is 
ethical,  the  report  said,  must  be  based  on  the 
form  and  terms  of  the  contract  as  well  as  the 
circumstances  under  which  it  is  made. 

In  another  action  related  to  the  issue  of 
free  choice,  the  House  adopted  a resolution 
condemning  the  current  attitude  and  method 
of  operation  of  the  United  Mine  Workers  of 
American  Welfare  and  Retirement  Fund  “as 
tending  to  lower  the  quality  and  availability 
of  medical  and  hospital  care  to  its  bene- 
ficiaries.” The  resolution  also  called  for  a 
broad  educational  program  to  inform  the  gen- 
eral public,  including  the  beneficiaries  of  the 
Fund,  concerning  the  benefits  to  be  derived 
from  preservation  of  the  American  right  to 
freedom  of  choice  of  physicians  and  hospitals 
as  well  as  observance  of  the  “Guides  to  Re- 
lationships Between  State  and  County  Med- 
ical Societies  and  the  UMWA  Welfare  and 
Retirement  Fund”  which  were  adopted  by 
the  House  last  June. 

The  Heller  Report 

Acting  on  the  report  of  the  Committee  to 
Study  the  Heller  Report  on  Organization  of 
the  American  Medical  Association,  the  House 
reached  the  following  decisions  on  ten 
specific  recommendations: 


1.  The  office  of  Vice-President  will  be  con- 
tinued as  an  elective  office. 

2.  The  offices  of  Secretary  and  Treasurer 
will  be  combined  into  one  office  to  be  known 
as  Secretary-Treasurer,  and  that  officer  will 
be  selected  by  the  Board  of  Trustees  from 
one  of  its  number. 

3.  The  duties  of  the  Secretary-Treasurer 
will  be  separated  from  those  of  the  Execu- 
tive Vice-President. 

4.  The  office  of  General  Manager  will  be 
discontinued,  and  the  new  office  of  Executive 
Vice-President  will  be  established.  The  lat- 
ter, appointed  by  the  Board  of  Trustees,  will 
be  the  chief  staff  executive  of  the  Associa- 
tion. 

5.  The  Council  on  Medical  Education  and 
Hospitals  and  the  Council  on  Medical  Service 
will  continue  as  standing  committees  of  the 
House  of  Delegates,  but  their  administrative 
direction  will  be  vested  in  the  Executive  Vice- 
President. 

6.  The  voting  members  of  the  Board  of 
Trustees  will  be  limited  to  eleven  — the  nine 
elected  Trustees,  the  President  and  the  Presi- 
dent-Elect. The  Vice-President  and  the 
Speaker  and  Vice-Speaker  of  the  House  of 
Delegates  will  attend  all  Board  meetings, 
including  executive  sessions,  with  the  right 
of  discussion  but  without  the  right  to  vote. 

7.  The  House  disapproved  of  the  proposal 
to  elect  the  Trustees  from  each  of  nine  phys- 
ician-population regions. 

8.  The  office  of  Assistant  Secretary  will  be 
discontinued,  and  a new  office  of  Assistant 
Executive  Vice-President  will  be  established. 

9.  The  Committee  on  Federal  Medical  Ser- 
vices will  be  retained  as  a committee  of  the 
Council  on  Medical  Service  and  will  not  be- 
come a part  of  the  Council  on  National  De- 
fense. 

10.  The  Speaker  of  the  House  will  appoint 
a joint  and  continuing  committee  of  six 
members,  three  from  the  Board  of  Trustees 
and  three  from  the  House,  to  redefine  the 
central  concept  of  A.M.A.  objectives  and 
basic  programs,  consider  the  placing  of 
greater  emphasis  on  scientific  activities,  take 
the  lead  in  creating  more  cohesion  among  na- 
tional medical  societies  and  study  socio- 
economic problems. 

The  accepted  recommendations  were  re- 
ferred to  the  Council  on  Constitution  and  By- 
laws with  a request  to  draft  appropriate 


— 12  — 


JANUARY  1958 


amendments  for  consideration  by  the  House 
at  the  1958  annual  meeting  in  San  Francisco. 

The  Forand  Bill 

The  House  condemned  the  Forand  Bill  as 
undesirable  legislation,  approved  the  firm 
position  taken  in  opposition  to  it  and  ex- 
pressed satisfaction  that  the  Board  of  Trus- 
tees has  appointed  a special  task  force  which 
is  taking  action  to  defeat  the  bill.  In  a related 
action,  giving  strong  approval  to  Dr.  Allman’s 
address  at  the  opening  session,  the  House 
adopted  a statement  which  said: 

“It  is  particularly  timely  that  our  President 
has  so  forcefully  sounded  the  clarion  call  to 
the  entire  profession  for  emergency  action. 
With  complete  unity,  definition  and  single- 
ness of  purpose,  closing  of  ranks  with  all  age 
groups  and  elements  of  our  organization  we 
must  at  this  time  stand  and  be  counted.  Thus 
we  can  exert  the  physician’s  influence  in 
every  possible  direction  against  invasion  of 
our  basic  American  liberties  in  the  form  of 
proposed  legislation  alleged  to  compulsorily 
insure  one  segment  of  the  population  against 
health  hazards  at  the  expense  of  all.” 

Health  Programs  for  Hospital  Employees 

A set  of  “Guiding  Principles  for  an  Occupa- 
tional Health  Program  in  a Hospital  Em- 
ployee Group”  was  approved  by  the  House. 
The  guides  were  developed  by  a joint  com- 
mittee of  the  American  Medical  Association 
and  the  American  Hospital  Association  and 
already  had  been  formally  approved  by  the 
A.H.A.  They  include  these  statements: 

“Employees  in  hospitals  are  entitled  to  the 
same  benefits  in  health  maintenance  and  pro- 
tection as  are  industrial  employees.  There- 
fore, programs  of  health  services  in  hospitals 
should  use  the  techniques  of  preventive  med- 
icine which  have  been  found  by  experience  in 
industry  to  approach  constructively  the 
health  requirements  of  employees. 

“It  is  essential  that  employee  health  pro- 
grams in  hospitals,  as  in  industry,  be  estab- 
lished as  separate  functions  with  independent 
facilities  and  personnel.  The  fact  that  hos- 
pitals are  engaged  in  the  care  of  the  sick  as 
their  primary  function  does  not  alter  the 
necessary  organizational  plan  for  an  effective 
occupational  health  program.” 

Asian  Influenza  Vaccine 

The  House  considered  three  resolutions 
dealing  with  the  Asian  influenza  immuniza- 
tion program  and  then  adopted  a substitute 


resolution  calling  attention  to  “certain  in- 
adequacies and  confusions  in  the  distribution 
of  vaccines”  and  directing  the  Board  of  Trus- 
tees to  seek  conferences  through  existing 
committees  “with  a view  to  establishing  a 
code  of  practices  regulating  the  future  dis- 
tribution of  important  therapeutic  products, 
so  that  the  best  interest  of  all  the  people  may 
be  served.”  The  resolution  pointed  out  that 
the  American  Medical  Association  already 
has  a joint  committee  with  the  American 
Pharmaceutical  Association  and  the  National 
Association  of  Retail  Druggists,  in  addition 
to  a liaison  committee  with  the  Drug  Manu- 
facturers Association. 

Medical  Rating  of  Physical  Impairment 

The  House  accepted  a 115-page  “Guide  to 
the  Evaluation  of  Permanent  Impairment  of 
the  Extremities  and  Back”  which  was  de- 
veloped by  the  Committee  on  Medical  Rating 
of  Physical  Impairment  as  the  first  in  a pro- 
jected series  of  guides.  The  delegates  com- 
mended the  committee  for  doing  “a  superb 
job  on  this  difficult  subject”  and  expressed 
pleasure  that  the  guides  will  be  published  in 
The  Journal  of  the  A.M.A.  The  guides  are  ex- 
pected to  be  of  particular  help  to  physicians 
in  determining  impairment  under  the  new 
disability  benefits  program  of  the  Social 
Security  Act. 

Miscellaneous  Actions 

Among  a wide  variety  of  other  actions,  the 
House  also: 

Directed  that  a new  committee  be  estab- 
lished in  the  Council  on  Industrial  Health  to 
study  neurological  disorders  in  industry; 

Noted  with  approval  the  establishment  of 
the  American  Medical  Research  Foundation, 
which  will  initiate  and  encourage  necessary 
medical  research  and  correlate  and  dissem- 
inate the  results  of  studies  already  under 
way; 

Decided  that  informational  materials  which 
are  sent  to  A.M.A.  delegates  should  also  be 
sent  to  all  alternate  delegates; 

Affirmed  that  it  is  within  the  limits  of 
ethical  propriety  for  physicians  to  join  to- 
gether as  partnerships,  associations  or  other 
lawful  groups  provided  that  the  ownership 
and  management  of  the  affairs  thereof  re- 
main in  the  hands  of  licensed  physicians; 

(Continued  on  Page  17) 


— 13  — 


MEDICARE 


Several  discussions  have  recently  been 
aired  in  Medical  Journals,  medical  meetings, 
and  the  like,  indicating  a ground  swell  of  in- 
dignation over  the  operation  of  “Medicare,” 
Medical  Care  for  Military  Dependents.  By 
and  large  the  arguments  and  complaints  fall 
into  the  following  categories: 

1.  Medicare  is  socialized  medicine  and 
therefore  sets  a pattern  for  the  full  pro- 
gram. 

2.  The  government  requires  that  the  Med- 
icare fee  be  accepted  as  payment  in  full 
for  the  service  rendered  — it  should  be 
an  indemnity  payment. 

3.  Government  will  regulate  and  control 
the  administration  of  the  program  in- 
creasingly as  time  goes  on. 

Lets  take  a look  at  the  “three  fears”  as 
they  appear  above. 

Referring  to  Number  1.  — Medicare  is 
Socialized  Medicine.  If  your  definition  of  so- 
cialized medicine  includes  government  pay- 
ment to  physicians  on  a set  fee  schedule  from 
tax  funds  — you  are  right.  But,  how  afraid 
of  this  should  the  medical  profession  be?  The 
answer?  Afraid  enough  to  be  wary  — wary 
of  expension  to  other  groups,  wary  of  further 
centralization,  but  certainly  not  so  wary  as  to 
bury  our  heads  in  the  sand.  Fight  it  in  the 
halls  of  Congress,  but  don’t  refuse  to  have 
your  own  people  administer  what  is  now  the 
law  of  the  land.  Medicare,  operated  by  you 
in  your  Medical  Association  office,  has  less 
chance  of  becoming  centralized  government 
medicine  than  when  operated  by  a central- 
ized insurance  company  or  any  agency  of 
government  over  which  you  have  no  control. 


Don’t  be  so  anxious  to  avoid  stepping  on  a 
pebble  that  you  fall  into  the  ocean.  Only  by 
controlling  the  incipient  monster  now  can  we 
keep  it  under  control  later. 

Referring  to  Number  2 . — We  have  a 
quarrel  with  the  physician  who  demands  the 
freedom  to  charge  what  he  feels  his  services 
are  worth.  At  the  same  time  no  physician 
should  receive  a blank  check  on  our  tax  dol- 
lars. A schedule  of  maximum  benefits  is  in- 
dicated to  smooth  over  this  administrative 
difficulty.  The  present  program  provides  for 
higher  charges  on  special  report.  It  appears 
that  the  major  objections  to  a schedule  of 
maximum  allowances  are  voiced  by  people 
who  don’t  do  any  Medicare  work  or  those 
who  routinely  charge  above  maximum  limits. 
For  public  relations  purposes,  it  would  ap- 
pear that  they  could  write  off  the  difference 
as  they  would  do  if  that  particular  patient 
had  an  indemnity  program.  It  is  doubtful 
that  a Pfc.  would  ever  get  much  of  a $700.00 
bill  paid  for  removal  of  his  wife’s  gall  bladder 
if  he  had  to  meet  the  difference  out  of  his 
pocket. 

A realistic  negotiated  fee  schedule  is  not 
harmful  if  abuses  of  the  government  are  met 
head  on  by  the  doctors  through  their  associa- 
tions. So  far,  our  experience  in  South  Dakota 
has  been  better  working  with  the  Army  than 
many  other  governmental  agencies. 

As  to  Number  3.  — We’re  pleased  as  punch 
that  other  program  administrations  and  phys- 
icians are  fearful  of  government  controls  of 
their  fiscal  operations.  Everyone  wonders 

(Continued  on  Page  16) 


— 14  — 


MEDICAL  LIBRARY  BOOKSHEF 


LEPTOSPIROSIS 

The  choice  of  this  topic  was  occasioned  by 
a recent  experience  with  this  disease.  Butch, 
a small  terrior  dog  and  a member  of  my 
household  became  ill,  refusing  to  eat  and 
what  was  more  significant,  seemed  unable  to 
wag  his  tail  and  was  extremely  sensitive  to 
touch  in  the  iregion  of  his  lower  back,  around 
the  kidneys.  Dr.  Stalheim,  the  local  vet- 
erinarian, diagnosed  his  case  as  leptospirosis 
and  Dr.  Charles  Cox,  the  Head  of  our  Micro- 
biology Dept,  confirmed  this  thru  a blood  test. 
After  a few  doses  of  penicillin  and  strepto- 
mycin, Butch  recovered.  Urine  tests  are  now 
being  taken  at  intervals  to  determine  whether 
or  not  he  is  a “shedder”  and  likely  to  trans- 
mit the  disease  to  other  dogs  or  even  people 
of  the  community.  Some  dogs  have  been 
known  to  be  carriers  for  as  long  as  a year 
with  the  virus  being  shed  in  the  urine. 

Dr.  Cox  has  done  considerable  research  on 
this  disease.  The  Sept. -Oct.  1957  issue  of 
Journal  of  Infectious  Diseases  contains  two 
articles  on  this  subject  one  written  by  Dr. 
Cox  and  the  other  by  him  in  collaboration 
with  A.  D.  Alexander  and  L.  C.  Murphy  of 
the  Division  of  Veterinary  Medicine  of  Walter 
Reed  Institute  of  Research.  The  first  article 
is  entitled,  “Standardization  and  Stabiliza- 
tion of  an  Extract  from  Leptospira  Biflexa 
and  Its  Use  in  the  Hemolytic  Test  for  Lep- 
tospirosis.” This  report  covers  the  prepara- 
tion, standardization  and  stabilization  of  Lep- 
tospirosis biflexa  antigen  for  use  in  the  HL 
reaction.  The  following  is  a summary  of  this 
article: 

“The  extraction  of  highly  reactive  extracts 
of  Leoptospira  biflexa.  and  their  use  in  the 
HL  (hemolytic  reaction)  procedure,  is  des- 


cribed. Standardization  of  the  reagents  in 
the  HL  procedure  has  been  accomplished 
initially  by  block  titrations,  followed  by 
periodic  linear  titrations,  which  effect  repro- 
ducible HL  titrations  of  serum.  HL  antigens 
have  been  stabilized  with  constant  activity 
for  long  periods,  which  decreases  the  neces- 
sity foir  frequent  titrations.” 

The  second  article  found  in  this  journal,  of 
which  Dr.  Cox  is  the  co-author,  evaluates  the 
use  of  the  antigen  in  the  serodiagnosis  of  hu- 
man leptospirosis.  The  hemolytic  test  (HL) 
was  subjected  to  an  extensive  evaluation 
with  46  different  serotype  rabbit  antiserums 
and  455  serums  from  cases  of  human  leptos- 
pirosis representing  at  least  24  different  sero- 
type infections.  The  conclusion  drawn  was 
that  the  currently  used  microscopic  agglu- 
tination tests  could  be  advantageously  sup- 
planted by  the  HL  test  in  the  serologic  diag- 
nosis of  human  leptospirosis. 

The  history  of  this  disease  is  described  in 
Thomas  G.  Hull’s  Diseases  Transmitted  From 
Animals  to  Man.  4th  ed.  Thomas,  1955.  It  is 
generally  accepted  that  Weil’s  classical  des- 
cription of  four  cases  of  the  disease  in  Europe 
in  which  there  was  a sudden  onset,  chills, 
prostration,  and  jaundice  described  lepto- 
spirosis. This  was  on  the  basis  that  L.  icttero- 
haemorragiae  was  the  first  etiological  agent 
identified  from  patients  diagnosed  as  having 
Weil’s  disease.  The  name  Weil’s  disease  is 
therefore  considered  applicable  for  the  more 
typical  syndrome  of  leptospirosis  irrespective 
of  what  strain  or  species  is  involved.  This  di- 
sease was  for  many  years  confused  with  yel- 
low fever  because  jaundice  occurred  in  both 
diseases  until  it  was  proved  that  yellow  fever 
was  caused  by  a filterable  virus.  The  com- 


— 15  — 


SOUTH  DAKOTA 


mon  hosts  are  cattle,  dogs  and  rodents. 

Along  with  the  “sputnik,”  credit  for  the 
recognition  of  leptospirosis  as  a disease  in 
cattle  goes  to  the  Russian  scientists.  In  North 
America  the  diagnosis  of  bovine  leptospirosis 
is  credited  to  Jungherr,  who  found  typical 
organisms  in  the  tissue  sections  of  three  milk 
cows  from  two  separate  farms  in  Connecticut. 
Presumably  the  first  human  case  attributed 
to  L.  pomona  was  reported  by  P.  B.  Beeson  et 
al  in  the  J.A.M.A.  v.  145:229,  1951.  The  pa- 
tient was  a meat-cutter  in  an  Atlanta  abat- 
toir handling  raw  beef  and  pork. 

According  to  Hull’s  description  of  the  di- 
sease in  man,  after  an  incubation  period  of 
3-9  days  the  disease  is  initiated  by  a sudden 
onset  with  chills,  high  fever,  gastro-intestinal 
symptoms,  including  nausea  and  vomiting, 
and  muscular  pain  especially  in  the  calf 
muscles.  During  this  febrile  period  which 
lasts  until  the  5th  day,  spirochetes  are  pres- 
ent in  the  blood  stream.  As  these  early  symp- 
toms are  characteristic  of  many  other  di- 
seases this  specific  infection  may  not  be 
recognized.  It  isn’t  until  the  second  stage 
(6th-13th  day)  that  icterus  hemoglobinuria 
and  tissue  hemorrhage  appear  and  by  this 
time  the  tissues  have  already  been  damaged; 
therapy  including  the  antibiotics  may  fail  and  ^ 
the  patient  may  die  even  if  the  fever  and 


EDITORIAL  PAGE— 

(Continued  From  Page  14) 
where  the  end  will  be  when  Uncle  starts  tell- 
ing us  to  operate  below  a certain  cost  per 
case  figure.  We  agree  that  things  are  pretty 
rough  (particularly  if  we  were  over  that 
figure)  when  that  happens.  But  as  a taxpayer 
we  question  an  $11.00  per  case  cost  on  a 
$71.00  per  case  payment  (about  15%)  when 
South  Dakota  does  it  for  about  V-k  per  cent 
and  Nebraska  even  less. 

Realistic  fiscal  administration  is  just  as 
much  in  order  within  certain  limits  as  is  good 
medical  care. 

Good  planning  — smooth  operation  — and 
reasonably  happy  relations  between  med- 
icine and  government  are  possible  if  we  ap- 
proach all  problems  with  proper  wariness  — 
without  fear. 

Its  like  bringing  an  uninvited  child  into  the 
world.  We  didn’t  ask  for  it,  but  we’ve  got  it. 
If  we  bring  it  up  right,  it  won’t  disgrace  or 
control  us. 


other  acute  symptoms  have  subsided.  Con- 
valesence  with  the  appearance  of  antibodies 
in  the  blood  begins  the  15th  day  and  recovery 
is  often  slow. 

Clinical  infection  in  laboratory  animals  and 
dogs  may  be  cured  with  the  antibiotics. 
Aureomycin  has  been  found  to  have  good 
therapeutic  value  and  for  carriers  likely  to 
shed  the  organism  in  their  urine  will  act  as 
a preventative. 

A good  article  on  leptospirosis  in  animals 
is  found  in  Animal  Diseases,  ihe  Yearbook  of 
Agriculture.  U.  S.  Dept,  of  Agriculture,  1956: 
226.  The  last  paragraph  indicates  the  mean- 
ing of  leptospirosis  to  the  health  of  the  com- 
munity. To  quote  “Persons  who  have  contact 
with  infected  animals  and  contaminated  ma- 
terials may  contact  the  disease.  Streams 
draining  from  infected  premises  may  carry 
the  organism  for  several  miles  and  be  a po- 
tential source  of  infection.”  A rodent  control 
program  is  highly  important  because  they  are 
carriers  of  this  disease. 

Mrs.  Esther  Howard 

Medical  Librarian 


* 


Protection  against  loss  of  income  from  acci- 
dent & sickness  as  well  as  hospital  expense 
benefits  for  you  and  all  your  eligible  depend- 
ents. 


PHYSICIANS  CASUALTY  & HEALTH 
ASSOCIATIONS 

OMAHA  31,  NEBRASKA 
SINCE  1902 


16  — 


JANUARY  1958 


THE  DIAGNOSIS  OF  EMOTIONAL 
DISORDERS  IN  CHILDREN— 

(Continued  From  Page  5) 
or  the  opposite  sex?  How  is  he  pun- 
ished and  for  what?  Which  parent  does 
the  punishing?  What  activities  does  the 
family  participate  in  together? 

5.  Does  he  like  school  and  how  does  he 
feel  about  his  teachers?  What  are  his 
favorite  subjects?  What  are  his  grades 
and  how  does  he  feel  about  them?  In 
what  extracurricular  school  activities 
does  he  participate? 

6.  Does  he  have  many  friends  and  what 
are  their  favorite  play  activities? 

7.  Are  favorite  play  activities  of  the  group 
variety  or  does  he  prefer  to  play  alone? 
How  does  he  feel  about  winning  and 
losing  in  competitive  games? 

8.  Does  he  have  many  fights,  and  for  what 
reasons  does  he  fight?  What  are  his 
subjective  feelings  when  he  is  angry 
and  what  does  he  do  about  them? 

9.  Rather  than  a direct  question  regard- 
ing masturbation  or  other  sexual  ac- 
tivity, it  is  better  to  ask,  “Do  you  have 
a girl  friend?” 

10.  What  does  he  want  to  be  when  he 
grows  up?  This  will  give  clues  regard- 
ing the  child’s  feelings  about  his  par- 
ents. 

11.  If  the  child  seems  quite  comfortable  in 
the  interview  situation  he  may  be  asked 
to  tell  his  most  pleasant  and  most  un- 
pleasant dream. 

The  report  of  the  diagnostic  findings  and 
the  need  for  help  should  be  made  in  the 
presence  of  both  parents  and  child.  This 
should  prevent  the  child  from  feeling  that 
you  have  betrayed  his  confidence. 

Perhaps  the  utilization  of  the  principles 
outlined  above  will  be  helpful  to  the  general 
physician  who  wishes  to  help  emotionally 
disturbed  children  and  their  parents. 


REPORT  ON  ACTIONS  OF  THE  HOUSE 
OF  DELEGATES— 

(Continued  From  Page  13) 

Instructed  that  the  appropriate  committee 
or  council  should  engage  in  conferences  with 
third  parlies  to  develop  general  principles 
and  policies  which  may  be  applied  to  the  re- 


lationship between  third  parties  and  mem- 
bers of  the  medical  porfession; 

Urged  state  medical  society  committees  on 
aging  and  insurance  to  make  continuing 
studies  of  pre-retirement  financing  of  health 
insurance  for  retired  persons; 

Endorsed  a suggestion  that  the  Committee 
on  Federal  Medical  Services  sponsor  a na- 
tional conference  on  veterans'  medical  care 
during  1958; 

Asked  the  Board  of  Trustees  to  study  the 
feasibility  of  having  the  Association  finance 
a thorough  investigation  of  the  Social  Secur- 
ity system  by  a qualified  private  agency; 

Suggested  that  physicians  and  their  friends 
make  a vigorous  effort  to  obtain  Congres- 
sional enactment  of  the  Jenkins-Keogh  Bills: 

Approved  the  “Suggested  Guides  to  Rela- 
tionships Between  Medical  Societies  and 

Voluntary  Health  Agencies"; 

Strongly  recommended  that  a completely 
adequate  and  competent  medical  department 
be  established  in  the  Civil  Aeronautics  Ad- 
ministration directly  responisble  to  the  CAA 
Administrator,  and 

Congratulated  the  General  Electric  Com- 
pany for  its  medical  television  presentations 
on  the  subject  of  quackery. 

Opening  Session 

At  the  Tuesday  opening  session  Rear  Ad- 
miral B.  W.  Hogan,  Surgeon  General  of  the 
U.  S.  Navy,  presented  the  Navy  Meritorious 
Public  Service  Citation  to  Dr.  Dwight  H. 
Murray  of  Napa,  Calif.,  immediate  past  presi- 
dent of  the  Association.  Contributions  to  the 
American  Medical  Education  Foundation,  for 
financial  aid  to  the  nation’s  medical  schools, 
were  presented  by  four  state  medical  so- 
cieties: California,  $143,043.25;  Utah,  $10,390; 
New  Jersey,  $10,000,  and  Arizona,  $8,040.  The 
Interstate  Post  Graduate  Medical  Association 
of  North  America  gave  $1,000,  and  the  Ill- 
inois State  Medical  Society  announced  that 
it  was  adding  $10,000  to  the  $170,450  pre- 
sented at  the  New  York  meeting  last  June. 

A.  A.  Lampert,  M.D. 

Delegate 


— 17  — 


MY  LAST  EDITORIAL 


For  many  years  some  of  our  surgeons  have  twitted  roentgenologists,  internists,  and  other 
diagnosticians  by  stating  that  the  “all-revealing  scalpel”  is  still  one  of  the  most  accurate  and 
scientific  of  all  diagnostic  procedures.  In  many  cases  the  knife  has  been  the  best  and  only 
diagnostic  instrument  which  finally  did  reveal  the  true  underlying  pathology.  And  at  this 
point  one  can  also  state  that  it  is  far  different  being  at  the  pointed  end  of  the  all-revealing 
scalpel  than  to  have  control  of  the  handle.  This  is  particularly  true  when  you  are  the  patient 
and  the  surgeon  tells  you  that  he  found  an  inoperable  squamus-cell  carcinoma  of  the  right 
lung.  One  does  not  feel  quite  so  happy  about  the  all-revealing  scalpel  at  such  a time.  How- 
ever, when  one  remembers  all  of  the  thousands  of  patients  who  have  had  their  pathological 
diseased  tissue  removed  and  have  been  cured,  one  realizes  that  after  all,  it  is  still  worthwhile 
to  have  exploratory  surgery.  So  whatever  one’s  personal  result,  one  has  to  take  what  comes 
in  life,  trying  to  be  as  optimistic  about  the  situation  as  possible  knowing  that  God  has  given 
the  human  race  the  ability  to  withstand  whatever  suffering  comes  one’s  way. 

I have  had  a life  that  has  been  full  and  enjoyable  so  far.  I’ve  enjoyed  a family  and  my 
professional  life  and  the  friendships  of  many.  I have  also  enjoyed  my  church  and  my  work 
in  fraternal  orders,  as  well  as  the  time  and  energy  spent  working  for  organized  medicine. 
My  interests  in  numerous  avocations  have  led  to  much  satisfaction  and  enjoyment  in  such 
fields  as  the  editor  of  the  South  Dakota  Journal  of  Medicine  and  Pharmacy,  and  such  groups  as 
the  American  Medical  Writers’  Association.  Other  interests  such  as  sports,  medicine,  public 
health  officer  and  my  work  as  school  physician  have  helped  to  widen  the  work  of  my  profes- 
sion. My  interests  in  athletics  such  as  baseball,  basketball,  football  and  playing  golf  have  led 
me  from  Miami  and  Atlantic  City  across  the  nation  to  Seattle  and  San  Francisco  and  even  as 
far  as  Honolulu.  Hunting  and  occasional  fishing  have  also  been  very  enjoyable,  so  all  in  all, 
one  cannot  help  but  look  forward  to  Life’s  Greatest  Adventure. 

One  leaves  the  scene  with  hope  that  the  medical  profession,  and  especially  the  younger 
men  will  continue  to  fight  the  encroachment  of  socialized  medicine,  even  though  the  battle 
seems  to  be  futile. 

To  those  many  friends  who  have  cheered  me  with  flowers  and  cards,  many  thanks.  To 
those  whom  I have  been  unable  to  acknowledge,  and  all  the  rest  of  my  friends  in  the  medical 
profession  throughout  South  Dakota,  all  I can  say  is  “Hail  and  Farewell.”  But  please  — no 
more  flowers.  I would  much  prefer  small  memorials  to  my  church  or  contributions  to  the 
research  division  of  the  South  Dakota  chapter  of  the  American  Cancer  Society. 

R.  G.  Mayer,  M.D. 

* This  special  editorial  was  dictated  by  Dr.  Mayer  to  his  daughter  at  his  bedside  in  St.  Luke’s  Hospital 
in  Aberdeen.  It  arrived  too  late  to  schedule  in  the  regular  editorial  page  and  to  be  listed  in  the  table 
of  contents. 


—•18  — 


JANUARY  1958 


TB  X-RAY  DRIVES 
NIXED  BY  USPHS 

Public  Health  Service,  act- 
ing on  advice  of  a committee 
of  medical  and  public  health 
leaders  called  in  to  re- 
evaluate recent  changes  in 
the  nature  of  the  tuberculosis 
problem,  is  recommending 
against  community-wide 
chest  X-ray  campaigns  for 
detetion  of  TB.  Instead  PHS 
recommends  that  commun- 
ities use  tuberculin  skin 
testing  as  a first  step  in  case- 
finding, followed  up  with  X- 
ray  examinations  for  those 
with  positive  reactions. 

The  service  suggests,  that 
X-ray  examinations  be  con- 
tinued on  selective  groups, 
those  with  greatest  risk,  such 
as  persons  confined  to  hos- 
pitals and  other  institutions, 
low-income  groups,  migrant 
workers  and  people  known 
to  have  been  exposed  to  the 
disease.  It  was  emphasized 
that  groups  to  be  given  X- 
rays  should  be  selected  lo- 
cally, with  the  choice  based 
on  the  local  tuberculosis 
problem,  the  expected  yield 
of  new  cases  and  the  ade- 
quacy of  diagnostic  and  treat- 
ment facilities  and  of  follow- 
up services. 

One  factor  given  consid- 
ration  in  reaching  the  de- 
cision, PHS  says,  is  “the 
problem  of  low-level  radia- 
tion exposure  from  X-rays.” 
To  further  reduce  radiation 
exposure,  both  of  the  opera- 
tors and  the  public,  PHS 
urges  periodic  inspection  of 
all  X-ray  equipment,  and  in- 
stallation of  further  protec- 
tive devices  were  indicated. 

Of  the  new  tuberculosis 
picture,  PHS  says:  “In  the 
last  15  years  . . . the  tuber- 
culosis problem  has  changed 


radically.  Some  areas  of  the 
country  are  now  practically 
free  of  active  cases  of  the 
disease.  In  other  areas, 
tuberculosis  continues  to  be 
a serious  problem,  particu- 
larly among  certain  groups. 
While  the  number  of  active 
cases  has  declined  almost  30 
percent  in  the  last  5 years, 
it  is  estimated  that  there  are 
still  about  250,000  persons 
with  active  tuberculosis  in 
the  United  States  today.” 

The  committee  that  ad- 
vised PHS  to  make  the 
recommendations  was  com- 
posed of:  Drs.  Russell  H. 
Morgan,  chief  radiologist, 
Johns  Hopkins  University 
Hospital,  and  special  consult- 
ant to  the  surgeon  general  on 
the  public  health  aspects  of 
radiation;  Ralph  Dwork,  di- 
rector of  health,  Ohio  State 
Department  of  Health;  Floyd 
Feldman,  medical  director. 
National  Tuberculosis  Asso- 
ciation; Joseph  Stocklen, 
tuberculosis  control  officer, 
Cleveland  and  Cuyahoga 
County  Health  Department. 


SEVENTH  DISTRICT 
MEDICAL  SOCIETY 
MEETS 

The  Seventh  District  Med- 
ical Society  met  in  Sioux 
Falls  at  Giovann’s  December 
3rd  at  6:30  P.M.  Guest 
speaker  was  Dr.  Frederick  C. 
Goetz  of  Minneapolis,  Minn- 
esota, who  spoke  on  “Current 
and  Future  Status  of  Oral 
Hypoglycemic  Drugs.”  Dr. 
Goetz  also  spoke  at  the  Vet- 
eran’s Hospital  on  the  “The 
Treatment  of  Acute  Renal 
Shutdown.” 
down.” 


INCOME  TAX  DEPT. 

CHANGES  RULES 

ON  GROUPS 

The  Internal  Revenue  Ser- 
vice announced  October  10th 
that  it  is  modifying  its  posi- 
tion with  respect  to  classifi- 
cation for  Federal  income 
tax  purposes  of  organized 
groups  of  doctors  practicing 
medicine. 

In  Rev.  Rul.  56-23,  C.B. 
1956-1,  598,  it  was  held  that 
a group  of  doctors  who  adopt 
the  form  of  an  association  in 
order  to  obtain  the  benefits 
of  corporate  status  for  pur- 
poses of  section  401(a)  of  the 
Internal  Revenue  Code  of 
1954  is  in  substance  a part- 
nership for  all  purposes  of 
the  Internal  Revenue  Code. 

It  is  now  the  position  of 
the  Service  that  the  fact  that 
an  association  establishes  a 
pension  plan  under  section 
401(a)  of  the  Internal  Rev- 
enue Code  of  1954  corres- 
ponding to  section  165(a)  of 
the  1939  Code  is  not  deter- 
minative of  whether  such  or- 
ganization will  be  classified 
as  a partnership  or  an  asso- 
ciation taxable  as  a corpora- 
tion. The  usual  tests  will  be 
applied  in  determining 
whether  a particular  organ- 
ization of  doctors  or  other 
professional  groups  has  more 
of  the  criteria  of  a corpora- 
tion than  a partnership. 


G.  P.  ACADEMY 
MEETS  IN  DALLAS 
MARCH  24-28 

The  tenth  annual  meeting 
of  the  American  Academy  of 
General  Practice  will  be  held 
in  Dallas  at  the  Memorial 
Auditorium  from  March  24 


— 19  — 


SOUTH  DAKOTA 


through  the  28th. 

The  Academy’s  Congress 
of  Delegates  will  convene  at 
2:00  P.M.  Saturday,  March 
22.  This  and  many  social 
functions  will  be  held  at  the 
Stattler-Hilton  Hotel. 


NEWS  NOTES 
Dr.  Robert  Van  Demark, 

Sioux  Falls,  attended  the 
meeting  of  the  American 
Academy  of  Cerebral  Palsy 
on  November  24,  25,  26  and 
27.  For  the  past  two  years 
he  has  been  a member  of  the 
program  committee  for  the 
national  meeting  and  in 
charge  of  the  scientific  ex- 
hibits. 


Ronald  E.  Guy  is  the  newly 
appointed  Rapid  City  sales 
representative  for  Lederle 
Laboratories  Division  of  the 
American  Cyanamid  Com- 
pany. He  is  a native  of  Sco- 
bey,  Mont. 


Sioux  Valley  Hospital  per- 
sonnel were  hosts  at  a dinner 
December  2nd  held  in  the 
cafeteria  of  the  hospital  for 
the  S.  F.  Med.  Assts.  Society. 
A excellent  program  ensued, 
as  well  as  a very  informative 
meeting.  It  proved  to  be 
beneficial  to  both  factions, 
hospital  and  the  medical 
assistants.  The  theme  of  the 
evening  was  “How  Can  We, 
Sioux  Valley  Hospital,  Help 
the  Medical  Assistants”  and 
“How  Can  You,  the  Medical 
Assistants,  Help  the  Hos- 
pital”? 


Dr.  Robert  Thompson, 

Yankton,  was  admitted  to  the 
American  College  of  Phys- 
icians at  the  November  9-10, 
1957,  meeting  of  the  Board  of 
Regents  at  the  College  head- 
quarters in  Philadelphia,  Pa. 


Dr.  Raymond  Boyce  was 
elected  president  of  the  inde- 
pendent Rapid  City  Medical 
Society. 

* * * 

Meeting  dates  for  the 
Sioux  Valley  Medical  Society 
in  Sioux  Falls  are  February 
25-26-27.  Dr.  Arnold  Myrabo, 
of  Sioux  Falls,  is  in  charge. 


AMERICAN  BOARD  OF 
OBSTETRICS  AND 
GYNECOLOGY 

The  next  scheduled  exam- 
ination (Part  II),  oral  and 
clinical  for  all  candidates 
will  be  conducted  at  the 
Egdewater  Beach  Hotel, 
Chicago,  Illinois,  by  the  en- 
tire Board  from  May  1 
through  17,  1958.  Formal 

notice  of  the  exact  time  of 
each  candidate’s  examination 
will  be  sent  him  in  advance 
of  the  examination  dates. 

Candidates  who  partici- 
pated in  the  Part  I examina- 
tions will  be  notified  of  their 
eligibility  for  the  Part  II  ex- 
aminations as  soon  as  pos- 
sible. 


S.  D.  JOURNAL 
HITS  N.  Y.  TIMES 

The  New  York  Times  of 
November  20th  quoted  at 
length  from  the  South  Da- 
kota Journal  of  Medicine. 
With  tongue  in  check,  John 
W.  Randolph  of  the  sports 
department,  tells  New 
Yorkers  about  the  hazards  of 
Pheasant  Hunter’s  Gout  as 
covered  in  a paper  by  Dr. 
Robert  Van  Demark  of  Sioux 
Falls.  The  two-column  treat- 
ment of  Dr.  Van  Demark’s 
paper  was  presented  as  a 
sports  feature  but  gave  ex- 
cellent reference  to  both  the 
author  and  publication. 


BLACK  HILLS 
ELECT  SHERRILL 
Sion  F.  Sherrill,  M.D., 

Belle  Fourche,  was  elected 
president  of  the  Black  Hills 
District  Medical  Society  at 
its  regular  meeting  Decem- 
ber 12th.  Raymond  Boyce, 
M.D.,  Rapid  City,  was  named 
vice-president  and  Wayne 
Geib,  M.D.,  Rapid  City,  was 
reelected  secretary-treasurer. 

Forty  one  physicians  at- 
tended the  meeting  in  Dead- 
wood.  Dr.  Charles  Cox,  U.  of 
South  Dakota  Medical  School 
was  the  speaker. 


ABERDEEN  ELECTS 
DR.  AGNES  KEEGAN 

The  Aberdeen  District 
Medical  Society  elected  of- 
ficers at  its  regular  monthly 
meeting  December  4th.  The 
new  president  is  Dr.  Agnes 
Keegan,  Vice-president,  Dr. 
G.  H.  Steele,  and  secretary- 
treasurer,  Dr,  W.  E.  Gorder. 

Dr.  Irina  Driver  trans- 
ferred from  the  Black  Hills 
District. 


— 20  — 


JANUARY  1958 


Dr.  Geib  directing  a step  in  performing  blood  dilutions  by  two  of 
the  students. 


“Some  22  technicians  from  throughout  the  state,  together 
with  a number  of  visiting  physicians  and  certified  technicians, 
contributed  to  make  what  apparently  was  a very  successful 
Blood  Bank  Workshop  held  at  the  Medical  School  November 
13-16.  The  program  which  was  the  direct  result  of  studies 
conducted  by  the  Blood  Bank  Committee  of  the  State  Medical 
Association  under  the  direction  of  Dr.  Geib  was  organized  by 
Dr.  Amos  C.  Michael,  Professor  of  Pathology  at  the  Univer- 
sity. Course  instruction  was  offered  by  Dr.  Charles  Cox,  Pro- 
' fessor  of  Microbiology,  and  through  the  fine  cooperation  of 
the  following  pathologists  in  the  state:  Drs.  Rank,  Aberdeen; 
I Carefoot,  Huron;  Gein,  Rapid  City;  Mitchell  and  Myrabo  from 
1 Sioux  Falls.  Other  pathologists  were  responsible  also  for  sub- 
! mitting  specimens  for  use  in  the  instructional  program.” 


Dr.  Rank  supervising  an  agglutination  procedure  as  performed  by 
several  technicians. 


P.  G.  DIABETES 
COURSE  OFFERED 

The  American  Diabetes 
Association  will  offer  its 
Sixth  Postgraduate  Course 
in  Diabetes  and  Basic  Meta- 
bolic Problems  in  Atlanta, 
Georgia,  January  22,  23  and 
24,  1958.  The  lectures  will  be 
held  in  the  auditorium  of  the 
Academy  of  Medicine,  Ful- 
ton County  Medical  Society. 

For  further  information 
and  registration  forms,  write 
to:  American  Diabetes  Asso- 
ciation, 1 East  45th  Street, 
New  York  17,  New  York. 


PHYSICIANS  WORK 
WITH  TECHNICIANS 

One  of  the  best  indications 
of  cooperation  between  tech- 
nicians and  physicians  is  evi- 
denced by  the  membership 
of  twenty-five  South  Dakota 
doctors  in  the  South  Dakota 
Society  of  X-Ray  Tech- 
nicians. 

Doctors  are  invited  to  be- 
long if  they  have  any  inter- 
est in  x-ray  work.  Dues  are 
$3.00  and  requests  for  infor- 
mation may  be  directed  to: 
Sister  Mary  Simplicita  R.  T. 
St.  Anthony’s  Hospital 
Martin,  South  Dakota 


— 21  — 


SOUTH  DAKOTA 


TEENAGERS  WORK 
FOR  POLIO 

Sixty-one  March  of  Dimes 
high  school  volunteers  from 
9 Eastern  South  Dakota 
counties  now  engaged  in  the 
organization’s  annual  drive 
plans  were  guests  in  Sioux 
Falls  Friday.  The  day’s  activ- 
ities consisted  of  a noon  lun- 
cheon at  which  time  Miss 
Nan  Davies,  Watertown,  1958 
State  March  of  Dimes  TAPS 
(Teens  against  Polio)  Chair- 
man, welcomed  the  teen- 
agers. 

Following  the  luncheon 
was  a conducted  tour  of  the 
Crippled  Children’s  Hospital 
and  School.  Dick  Olson,  As- 
sistant Director  at  the  school, 
spoke  briefly  of  his  actual 
experience  as  a polio  victim. 
The  young  March  of  Dimes 
volunteers  had  the  oppor- 
tunity of  seeing  a physical 
therapist  working  with  a 
polio  patient.  The  day’s  ac- 
tivities were  concluded  with 
the  appearance  of  the  TAPS 
March  of  Dimes  students  on 
Time  for  Teens,  TV  program 
— KELO  TV. 


COMMITTEES  ACTIVE 
AS  YEAR  ENDS 

Committee  activity  in  the 
Medical  Association  picked 
up  as  programs  proceed  into 
the  new  year.  The  Commit- 
tee on  Workmans  Compen- 
sation met  in  Pierre,  Decem- 
ber 8th.  The  Committee  on 
Medical  Economics  met  De- 
cember 15th  and  are  sched- 
uled for  January  18th  and  the 
Committe.e  on  Indigent  Care 
is  scheduled  for  January  17th 
meeting  with  hospital  admin- 
istrators and  county  commis- 
sioners. 


PREVIEW  OF  THE  1958 
MLA  MEETING 

The  Fifty-seventh  annual 
meeting  of  the  Medical  Li- 
brary Association  will  be 
held  in  Rochester,  Minnesota 
from  June  2 through  June  6, 
1958  with  headquarters  at 
the  Hotel  Kahler.  The  theme 
of  the  Rochester  meeting  will 
be  “Advances  in  Medical  Li- 
brary Practice.”  Mr.  Thomas 
E.  Keys,  Librarian  of  the 
Mayo  Clinic,  is  Convention 
Chairman  and  letters  of  in- 
quiry should  be  addressed  to 
him. 


INTERNISTS  MEET 
INTERNATIONALLY 

The  Fifth  International 
Congress  of  Internal  Med- 
icine will  be  held  in  Phila- 
delphia April  23-26,  1958. 
World  reknowned  medical 
authorities  will  appear  on  the 
program. 

This  is  the  first  meeting  of 
the  Society  to  be  held  in  'iithe 
United  States.  It  was  ar- 
ranged on  invitation  of  the 
American  College  of  Phys- 
icians and  is  intended  to  en-  ; 
courage  greater  participation 
of  American  Physicians  in  j 
the  International  Society  and  j 
to  give  foreign  members  an  J 
opportunity  to  learn  more  i 
about  developments  in  the  j 
Medical  sciences.  | 

The  Society  has  over  4,000 
members  in  34  countries. 

Information  and  applica- 
tions can  be  secured  by  writ-  } 
ing  the  Secretary  — General, 
4200  Pine  Street,  Phila-  i, 
delphia  4,  Pa. 


MAYO  PROGRAM  i 

SET  FOR  APRIL 

Staff  members  of  the  Mayo  | 
Clinic  and  the  Mayo  Founda-  | 
tion  for  Medical  Education  | 
and  Research  will  present 
again  this  year  a three-day  t 
program  of  lectures  and  dis-  | 
cussions  on  problems  of  cur-  ■ 
cent  interest  in  general  med-  'i 
icine  and  surgery.  Dates  of  ; 
the  meeting  are  April  14-15-  i 
16.  •( 
There  are  no  fees  for  this  jl 
program.  |i 

The  number  of  physicians  |j 
who  can  be  accommodated  is  li 
necessarily  limited.  Those  t 
wishing  to  attend  should  J 
communicate  with  Mr.  R.  C.  | 
Roesler,  Mayo  Clinic,  Roches-  i; 
ter,  Minnesota.  | i 


— 22  — 


JANUARY  1958 


HAROLD  S.  BAILEY.  PH.D. 
EDITOR 

Division  of  Pharmacy 
South  Dakota  State  College 
Brookings,  South  Dakota 


t 


— 23  — 


ACEUTICAL 

'p€ifien^ 


THE  PRESCRIPTION  PHARMACIST 
TODAY* 
by 

Wallace  Croatman  and  Paul  B.  Sheatsley** 
New  York  City,  New  York 


How  often  does  the  general  public  go  to 
the  retail  druggist  for  medical  advice? 

To  what  extent  do  practicing  physicians 
rely  on  pharmacists  for  information  about 
new  drugs? 

What  does  a druggist  usually  say  to  a cus- 
tomer who  complains  about  the  cost  of  a 
prescription? 

This  paper  will  attempt  to  answer  these 
and  other  key  questions  about  a little-under- 
stood person  in  the  health  field  — the  retail 
pharmacist. 

How  the  Survey  Was  Made 

The  report  is  based  on  one  of  three  sets  of 
basic  tabulations  of  the  health  attitude  sur- 
vey conducted  by  The  National  Opinion  Re- 
search Center  during  1955  under  a grant  from 
the  Health  Information  Foundation.  Other 
sets  of  tabulations  presented  the  responses 
of  a cross-section  of  the  general  public  and 
of  a national  sample  of  physicians  to  a large 
number  of  questions  about  health  and  med- 
ical care.  This  study  deals  with  the  replies 

*This  is  the  first  of  a series  of  articles  presenting 
a factual  study  of  the  pharmacists  role  in  the 
health  field.  The  study  was  made  possible  by  a 
grant  from  the  Health  Information  Foundation. 
**Wallace  Croatman  is  a free-lance  writer  in  the 
health  field  and  Paul  B.  Sheatsley  is  a research 
worker,  National  Opinion  Research  Center,  Uni- 
versity of  Chicago. 


of  a national  sample  of  pharmacists  to  ques- 
tions of  a similar  or  parallel  nature. 

The  pharmacists  whose  replies  are  here 
reported  are  the  owners,  managers,  or  senior 
pharmacists  of  drug  stores  which  were  named 
by  the  general  public  in  the  course  of  earlier 
interviews.  Each  of  the  2,379  individuals  in- 
terviewed in  that  survey  was  asked,  “Where 
do  you  usually  go  to  get  a prescription 
filled?”  The  names  of  approximately  1,100  j 
drug  stores  were  volunteered,  and  from  these 
a sample  of  496  were  selected  systematically, 
with  the  probability  of  any  particular  store 
being  drawn  made  proportionate  to  the  num- 
ber of  times  it  was  mentioned.  In  most  cases 
the  owner  or  manager  of  the  store  was  the 
person  interviewed.  But  when  the  owner  or 
manager  was  not  himself  a registered  phar- 
macist (as  was  the  case  in  11  per  cent  of  the 
stores),  the  interview  was  held  with  the  per- 
son he  designated  as  his  senior  pharmacist. 

It  is  apparent  that  this  sampling  design  , 
does  not  produce  a representative  cross-sec- 
tion either  of  retail  drug  stores  or  of  regis-  i 
tered  pharmacists.  Rather  it  represents  the  : 
pharmacist-half  of  a sample  of  customer-  i 
pharmacist  relationships.  As  a result,  the 
sample  is  heavily  weighted  toward  stores  ' 
which  do  a large  prescription  business  (aside 
from  sales  of  proprietaries,  cosmetics,  food,  ♦ 


— 24  — 


JANUARY  1958 


sundaries),  and  it  includes  only  those  phar- 
macists who  exercise  chief  responsibility  for 
the  management  of  the  prescription  business 
in  retail  stores. 

This  type  of  sample  design  was  dictated  by 
the  two  major  objectives  of  the  interviews 
with  pharmacists.  The  pharmacist  was  re- 
garded as  a person  with  whom  the  public  gen- 
erally has  close  contact  in  matters  of  health 
and  medical  care.  In  his  role  of  informant 
and  sometimes  adviser  to  his  customers,  and 
of  professional  observer  of  a part  of  the  pub- 
lic’s health  behavior,  the  pharmacist  was  ex- 
pected to  provide  valuable  supplementary 
information  to  that  already  obtained  from 
physicians  and  the  public  itself,  concerning 
people’s  attitudes  and  practices  with  respect 
to  health  and  medical  care.  The  sample  was 
so  designed,  therefore,  that  only  pharmacists 
employed  in  retail  stores,  and  thus  in  fre- 
quent contact  with  the  public,  would  be  in- 
terviewed, and  that  those  employed  in  stores 
serving  large  numbers  of  regular  prescription 
customers  would  have  a greater  chance  of 
being  interviewed  than  those  in  stores  with  a 
smaller  prescription  business. 

Secondly,  the  pharmacist,  through  his  re- 
lations with  the  doctors  in  the  local  commun- 
ity and  with  the  manufacturers  and  dis- 
tributors of  prescription  drugs,  was  regarded 
as  an  important  link  in  the  chain  of  medical 
care.  The  pharmacist’s  conceptions  of  his 
own  professional  role,  and  his  satisfactions 
and  dissatisfactions  with  his  relationships 
with  other  health  professionals,  were  as- 
sumed to  have  some  bearing  on  the  effective- 
ness of  the  total  establishment.  For  this  rea- 
son, in  stores  where  more  than  one  phar- 
macist was  employed,  the  interview  was  al- 
ways conducted  with  the  one  responsible  for 
managing  the  prescription  business  and  thus 
in  closest  relationship  with  physicians,  drug 
distributors,  and  detail  men. 

The  sample  may  thus  be  described  as  rep- 
resentative of  the  opinions  and  behavior  of 
those  pharmacists  with  whom  the  public  has 
closest  contact.  As  such,  it  has  unique  value 
for  a study  of  the  pharmacist’s  role  in  health 
education,  and  for  the  information  these  re- 
spondents provide  as  a result  of  their  own 
observation  of  the  public’s  attitudes  and 
practices. 

In  the  basic  tabulations  of  survey  data. 


the  percentaged  distribution  of  responses  to 
most  of  the  questions  is  presented  for  the 
total  group  of  pharmacists  interviewed,  and 
also  for  eight  different  sub-classifications  of 
the  total.  The  eight  variables  selected  for 
routine  cross-tabulation  are  defined  as  fol- 
lows: 

Age:  Self-explanatory. 

Region:  “Northeast”  refers  to  pharmacists 
practicing  in  the  states  within  the  New  Eng- 
land and  Middle  Atlantic  regions,  as  defined 
by  the  U.  S.  Census.  “North  Central”  includes 
the  East  North  Central  and  West  North  Cen- 
tral regions.  “South”  combines  the  South 
Atlantic,  East  South  Central,  and  West  South 
Central  regions.  “West”  refers  to  the  Moun- 
tain and  Pacific  regions. 

Size  of  Community:  “Large  Metropolitan 
Areas”  refers  to  pharmacists  practicing  with- 
in the  14  largest  metropolitan  areas,  as  de- 
fined by  the  1950  U.  S.  Census.  Each  of  these 
metropolitan  areas  has  a population  of  one 
million  or  more.  “Small  Metropolitan  Areas” 
are  those  with  less  than  one  million  popula- 
tion. “Urban  counties”  are  non-metropolitan 
counties  having  within  them  a city  of  10,000 
or  more  population.  “Rural  counties”  are  non- 
metropolitan counties  having  no  city  as  large 
as  10,000. 

Total  Volume  of  Business:  The  owner  or 
manager  was  asked  to  report  the  approximate 
amount  of  the  store’s  total  gross  sales  during 
the  12  months  prior  to  the  interview.  The 
figure  includes,  of  course,  not  only  prescrip- 
tion sales,  but  total  sales  of  all  items. 

Proportion  of  Total  Business  Contributed 
by  Prescriptions:  The  owner  or  manager  was 
asked:  “About  what  proportion  of  your  store’s 
total  business  comes  from  the  filling  of  pres- 
criptions — about  two-thirds,  about  half, 
about  one-third  or  less?” 

Attitude  Toward  Pharmacist  as  Medical 
Adviser  to  Public:  Each  respondent  was 
asked:  “Do  you  think  the  general  public  ought 
to  be  encouraged  to  ask  the  pharmacist  ques- 
tions about  health  and  medical  care,  or  should 
the  public  not  be  encouraged  to  ask  phar- 
macists such  questions?”  Those  who  quali- 
fied their  answers  (certain  questions,  under 
certain  conditions,  etc.)  are  combined  with 
the  small  group  who  had  no  opinion. 

Attitude  Toward  Pharmacy  as  Field  for 
Young  Man:  Pharmacists  are  classified  ac- 
cording to  their  answers  to  the  following 


— 25  — 


New  authoritative  studies  show  that  Kynex  dosage  can  be  reduced  even  further  than  that 
recommended  earlier.^  Now,  clinical  evidence  has  established  that  a single  (0.5  Gm.)  tablet 
maintains  therapeutic  blood  levels  extending  beyond  24  hours.  Still  more  proof  that  Kynex 
stands  alone  in  sulfa  performance— 

• Lowest  Oral  Dose  In  Sulfa  History— 0.5  Gm.  (1  tablet)  daily  in  the  usual  patient  for 
maintenance  of  therapeutic  blood  levels 

• Higher  Solubility— effective  blood  concentrations  within  an  hour  or  two 

• Effective  Antibacterial  Range— exceptional  effectiveness  in  urinary  tract  infections 

• Convenience— the  low  dose  of  0.5  Gm.  (1  tablet)  per  day  offers  optimum  convenience 
and  acceptance  to  patients 

1.  Nichols,  R.  L.  and  Finland,  M.:  L Clin.  Med.  49:410,  1957. 


NEW  DOSAGE.  The  recommended  adult  dose  is  1 Gm.  (2  tablets  or  4 teaspoonfuls  of  syrup) 
the  first  day,  followed  by  0.5  Gm.  (1  tablet  or  2 teaspoonfuls  of  syrup)  every  day  thereafter, 
or  1 Gm.  every  other  day  for  mild  to  moderate  infections.  In  severe  infections  where  prompt, 
high  blood  levels  are  indicated,  the  initial  dose  should  be  2 Gm.  followed  by  0.5  Gm.  every 
24  hours.  Dosage  in  children,  according  to  weight;  i.e.,  a 40  lb.  child  should  receive  14  of  the 
adult  dosage.  It  is  recommended  that  these  dosages  not  be  exceeded. 

TABLETS:  Each  tablet  contains  0.5  Gm.  (714  grains)  of  sulfamethoxypyridazine.  Bottles  of 
24  and  100  tablets. 

SYRUP;  Each  teaspoonful  (5  cc.)  of  caramel-flavored  syrup  contains  250  mg.  of  sulfa- 
methoxypyridazine. Bottle  of  4 fl.  oz. 


LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 
*Reg.  U.  S.  Pat.  Off. 


SOUTH  DAKOTA 


question:  “Do  you  consider  pharmacy  a very 
good  field  for  a young  man  to  enter,  or  only 
a fairly  good  field,  or  not  good  at  all  as  a 
career?” 

Attitude  Toward  Coverage  of  Drug  Costs 
by  Insurance:  After  three  earlier  questions 
on  hospital,  surgical,  and  general  medical  in- 
surance, all  pharmacists  were  asked:  “Would 
you  yourself  favor  or  oppose  the  idea  of  in- 
cluding prescription  costs  in  the  contracts 
written  by  health  insurance  companies?” 
They  are  classified  according  to  their  reply 
to  this  question. 

Detailed  statistical  data  from  this  survey 
of  pharmacists,  broken  down  by  age,  region, 
community  size,  volume  of  store’s  business, 
and  other  variables,  are  available  to  persons 
interested  in  doing  further  research  in  this 
area.  The  following  pages  give  the  high 
spots  of  the  study. 

Pharmacists  as  They  See  Themselves 

The  personal  side  — By  and  large,  the 
pharmacists  in  this  survey  are  well  estab- 
lished in  their  business  and  in  the  commun- 
ities where  they  live  and  work.  Seven  out  of 
every  ten  are  40  years  of  age  or  older;  six  out 
of  ten  have  been  licensed  to  practice  phar- 
macy for  at  least  20  years. 

Almost  half  of  them  never  worked  in  a 
drug  store  outside  the  county  or  metropolitan 
area  where  they  are  now  situated.  A comfort- 
able majority  — three  out  of  five  pharmacists 
— have  spent  25  years  or  more  in  the  same 
area.  More  than  half  — 54  per  cent  — have 
worked  in  three  stores  or  less  throughout 
their  professional  careers,  and  about  the  same 
percentage  have  been  with  the  same  store 
for  ten  years  or  more. 

Where  trade  and  social  organizations  are 
concerned,  the  pharmacists  stand  out  as  a 
group  of  “joiners.”  Nine  out  of  ten  belong 
to  at  least  one  trade  or  pharmaceutical  or- 
ganization, and  many  belong  to  more  than 
one.  (Eight  per  cent  hold  office  in  at  least 
one  such  group.)  National,  state,  regional, 
county,  and  local  pharmaceutical  associations 
claim  77  per  cent  of  the  men  surveyed.  The 
National  Association  of  Retail  Druggists 
claims  49  per  cent,  and  local,  state,  and  re- 
gional drug  associations  20  per  cent. 

In  addition,  more  than  seven  out  of  ten 
pharmacists  belong  to  one  or  more  civic  or- 
ganizations, and  one  man  in  every  three  be- 
longs to  three  or  more  such  groups.  Lodges 


and  fraternal  orders  (Elks,  Masons,  etc.)  lead 
in  popularity,  followed  by  civic  and  service 
clubs  (eg..  Lions,  Kiwanis),  and  business  or 
commercial  groups  (Chamber  of  Commerce, 
Board  of  Trade,  etc.).  About  17  per  cent  of 
all  pharmacists  hold  office  in  one  or  more 
civic  or  social  groups. 

“Are  you  ever  asked  to  take  a prominent 
part  in  any  of  the  local  functions  sponsored 
by  community  groups?”  When  asked  this 
question,  57  per  cent  of  the  druggists  said 
“yes.”  As  a rule,  the  smaller  the  community, 
the  more  likely  the  pharmacist  was  to  answer 
“yes.”  While  only  45  per  cent  of  the  druggists 
in  large  metropolitan  areas  take  an  active 
part  in  community-group  functions,  72  per 
cent  of  the  men  in  rural  counties  do  so. 

Literally  99  per  cent  of  the  pharmacists  in 
the  study  are  males,  and  the  same  percentage 
are  white.  As  for  religious  preference,  62 
per  cent  are  Protestant,  21  per  cent  Catholic, 
14  per  cent  Jewish,  and  3 per  cent  “none.” 

About  95  per  cent  of  the  druggists  were 
born  in  this  country,  and  two  out  of  three 
indicate  that  their  fathers  were  also  born  in 
the  United  States.  Only  about  one  out  of  five 
pharmacists  says  that  his  father’s  occupa- 
tion was  directly  connected  with  the  health 
field.  Specifically,  17  per  cent  of  the  men 
surveyed  had  fathers  who  were  pharmacists 
or  in  some  other  way  connected  with  a drug 
store;  in  another  5 per  cent  of  the  cases  the 
fathers  were  physicians,  dentists,  or  other- 
wise associated  with  the  health  field. 

All  but  7 per  cent  of  the  druggists  attended 
a school  of  pharmacy.  Midwestern  schools 
claimed  31  per  cent  of  the  group,  Southern 
Schools  28  per  cent.  Eastern  schools  23  per 
cent,  and  Far  Western  schools  9 per  cent.  A 
handful  of  men  went  to  schools  outside  the 
United  States. 

Financially,  the  pharmacists  in  this  study 
seem  to  be  doing  as  well  or  better  than  men 
in  comparable  fields.  Roughly  half  of  them 
report  an  annual  personal  income  from  phar- 
macy, before  taxes  of  $7,500  or  more.  The 
bottom  15  per  cent  make  less  than  $5,000  a 
year,  while  the  top  17  per  cent  take  home 
$12,500  or  more. 

The  great  majority  of  them  say  they  are 
satisfied  with  their  incomes.  Some  39  per 
(Continued  on  Page  36) 


— 26  — 


THE  NEW  ERA  IN  MEDICAL  RESEARCH* 
by 

John  T.  Connor** 

Rahway,  New  Jersey 


The  New  Era  In  Medical  Research,  about 
which  I shall  talk,  is  only  just  beginning.  It 
was  born  when  the  Congress,  reflecting  a 
growing  hope  of  the  American  people,  de- 
cided that  it  would  henceforth  be  the  policy 
of  the  United  States  to  try  to  conquer  disease 
through  research,  whatever  the  cost. 

To  carry  out  this  new  policy,  the  Con- 
gress turned  to  its  own  postwar  creation,  the 
National  Institutes  of  Health,  research  arm 
of  the  Public  Health  Service.  It  had  grown 
— almost  unnoticed  by  the  public  — from 
only  one  small  Institute  — Cancer  — in  1946, 
to  seven  institutes  and  a budget  of  $98  mil- 
lion ten  years  later. 

In  June  1956  the  Congress,  ignoring  both 
an  economy  wave  and  the  President’s  bud- 
get, nearly  doubled  the  appropriation  for 
NIH,  raising  it  from  $98  million  to  $183  mil- 
lion in  one  stroke,  and  to  $211  million  this 
year.  The  result  of  this  act  was  eloquently 
described  last  Spring  by  Dr.  James  Shannon, 
Director  of  the  NIH,  when  he  testified  before 
the  Senate  Appropriations  Subcommittee. 

“For  the  first  time  in  the  history  of  med- 
ical research,  either  in  this  country  or 
abroad,”  he  said,  “the  limitation  on  progress 
is  due  more  to  manpower  facilities  than  to 
moneys  available  for  current  support  or  re- 
search.” 

* Speech  delivered  before  The  Association  of 
Military  Surgeons  at  the  Hotel  Statler,  Washing- 
ton, D.  C.,  October  29,  1957. 

**President,  Merck  & Co.,  Inc. 


In  these  words.  Dr.  Shannon  has  aptly  de- 
fined the  new  era  in  medical  research,  which 
is  a development  of  the  first  magnitude.  It 
may  significantly  change  the  lives  of  most 
of  the  people  in  this  room. 

How  did  it  come  about?  Perhaps  the  an- 
swer to  that  question  had  better  be  left  to 
the  historians.  But  I think  it  is  safe  to  pre- 
dict that  one  of  the  causes  will  be  traced  back 
to  the  effect  on  the  average  citizen  when, 
twelve  years  ago,  he  saw  the  first  pictures  of 
the  mushroom  cloud  over  Alamogordo.  How, 
he  immediately  wanted  to  know,  had  man- 
kind been  able  to  jump  so  far  into  the  future 
in  one  leap?  What  he  was  also  told,  but  has 
forgotten,  is  that  all  the  gold  in  Fort  Knox 
could  not  have  done  the  job  without  the  basic 
equation  of  mass  and  energy,  namely,  e=mc2, 
which  came  out  of  the  remarkable  brain  of 
Albert  Einstein  and  didn’t  cost  anything  at 
all  — in  dollars,  that  is. 

What  he  remembers  of  the  answer  is  that 
it  was  planned  that  way.  The  scientists  had 
said  they  could  make  the  atom  bomb,  all  they 
needed  was  lots  of  money;  the  more  the 
money,  the  faster  the  bomb.  It  took  $2  billion 
to  get  it  on  time.  He  came  to  believe  that 
time  was  divisible  by  research  dollars. 

Next,  our  average  citizen  became  aware 
of  the  fact  that  the  research  laboratories  of 
the  universities  and  pharmaceutical  com- 
panies, sometimes  with  government  assist- 
ance, had  been  turning  out  a dazzling  series 
of  discoveries:  vitamins,  the  sulfa  drugs, 
penicillin,  cortisone,  streptomycin,  the  broad 


— 27  — 


SOUTH  DAKOTA 


spectrum  antibiotics,  drugs  for  mental  health, 
and,  finally,  a protection  against  the  dreaded 
polio.  How  about  speeding  up  this  process? 
he  asked.  With  characteristic  enthusiasm  and 
generosity  he  set  about  to  find  the  money  to 
do  so,  operating  on  the  attractive  hypothesis 
that  research  in  adequate  quantities  would 
enable  us  to  cure  or  prevent  cancer,  heart 
disease,  mental  illness,  and  a host  of  other 
ancient  scourges;  the  more  research,  the  fas- 
ter we  would  finish  the  job. 

$400  Million  For  Research 

The  results,  measured  in  dollars,  are  quite 
impressive.  The  federal  government  is  foot- 
ing better  than  half  the  bill  — in  the  neigh- 
borhood of  a quarter  of  a billion  dollars.  But 
the  pharmaceutical  industry,  with  $127  mil- 
lion this  year,  is  not  far  behind.  The  total 
expenditures  in  1957  for  medical  research, 
which  also  include  sizeable  contributions  by 
the  universities,  foundations,  and  citizen 
health  groups,  such  as  the  American  Cancer 
Society  and  the  American  Heart  Association, 
will  come  pretty  close  to  $400  million. 

A good  up-to-date  American  is  scarcely 
frightened  by  such  a sum.  He  would  rather 
see  tax  money  go  into  a test  tube  than  into  a 
pork  barrel.  He  may  sometimes  balk,  a little 
at  paying  over  the  prescription  counter  for 
research  by  the  pharmaceutical  industry.  But 
when  he  watches  the  new  drug  go  to  work 
on  the  disease  that  is  frightening  his  sick 
wife  or  child,  he  finds  this,  perhaps,  the, least 
painful  way  to  buy  medical  research. 

It  is  now  pretty  clear  from  the  evidence 
that  the  average  citizen  is  determined  to  pur- 
chase a longer  and  a healthier  life  with  what- 
ever dollars  it  takes.  His  determination  is 
pretty  powerful,  and  the  money  he  has  ad- 
vanced to  date  is  likely  to  be  a mere  token 
of  what  is  to  come. 

The  job  ahead  of  us  now  is  not  to  decide 
whether  this  job  is  to  be  done.  It  is  to  decide 
how.  We  have  boosted  the  total  expenditure 
for  medical  research  in  the  past  ten  years  at 
a rate  twice  that  of  the  gross  national  income, 
with,  as  I said,  very  little  criticism.  There 
has  been  far  too  little,  even  of  the  construc- 
tive variety.  This  is  not  a healthy  situation. 

Last  summer  we  at  Merck  decided  that  it 
might  be  a useful  public  service  to  take  an 
overall  look  at  this  picture.  This  new  era  is 
in  an  early  enough  stage  so  that  change,  if 
change  is  called  for,  would  come  a lot  easier 


now  than  later.  It  just  makes  good  sense,  we 
thought,  to  try  to  identify  and  solve  major 
conflicts  and  difficulties  before  they  became 
too  big  to  handle. 

Opinion  Survey  of  Medical  Research  Leaders 

We  commissioned  the  firm  of  Douglas  Wil- 
liams Associates,  which  had  conducted  sev- 
eral successful  surveys  in  the  scientific  field, 
to  ask  a nationwide  sample  of  medical  re- 
search leaders  to  identify  and  comment  on 
the  major  problems  that  had  arisen  as  a re- 
sult of  the  recent  dramatic  increases  in  funds. 
These  leaders  were  chosen  by  the  Williams 
organization  from  government,  the  pharma- 
ceutical industry,  universities,  research  in- 
stitutes, foundations,  and  the  fundraising  or- 
ganizations in  the  health  field.  Over  100  in- 
terviews were  conducted,  ranging  from  one 
hour  to  half  a day. 

I have  just  received  the  preliminary  re- 
sults of  the  survey,  and  this  is  one  of  the 
things  I want  to  discuss  with  you  today.  Al- 
though there  was  intense  interest  in  the  sur- 
vey, there  was  no  real  consensus  of  opinion 
on  any  major  problem.  There  was  even  a 
noticeable  lack  of  considered  judgment. 
People  recognized  this  and  said  that  critical 
studies  are  well  overdue.  They  welcomed  the 
appointment  by  Secretary  Folsom  of  a group 
of  Consultants  on  Medical  Research  and  Edu- 
cation under  the  chairmanship  of  Dr.  Stan- 
hope Bayne- Jones.  The  appointment  of  this 
group  was  announced  as  our  survey  was 
getting  under  way.  Recently,  Dr.  Bayne- 
Jones  asked  whether  we  would  make  the  re- 
port available  to  his  group,  and  I told  him  we 
would  be  glad  to  do  so. 

Specific  Survey  Findings 

Now  to  the  specific  findings: 

The  unprecedented  amount  of  available 
money  has  made  a real  impact. 

There  is  skepticism  about  the  wisdom  of 
the  Federal  Government  becoming,  through 
appropriations,  the  dominant  factor  in  this 
field. 

There  is  widespread  suspicion  that  big 
sums  are  being  wasted  on  projects  that  had 
no  better  excuse  for  existence  than  that 
they  were  invented  to  get  a piece  of  that  easy 
federal  money.  But  there  is  also  delight  in 
many  quarters  that  Congress  is  finally  spend- 
ing for  the  conquest  of  disease  something  in 
the  neighborhood  of  the  cost  of  the  U.  S.  S. 
Forrestal. 


— 28  — 


JANUARY  1958 


There  is  some  real  concern,  however,  that 
the  public  is  being  misled  into  believing  that 
we  can  buy  discovery  with  money;  that  nine 
times  as  much  money  in  medical  research 
will  cure  nine  times  as  many  diseases  or  one 
disease  in  one-ninth  the  time.  As  one  of  those 
interviewed  put  it:  “You  can’t  produce  a baby 
in  one  month  simply  by  making  nine  women 
pregnant.” 

Most  persons  said  that  one  key  to  the  fu- 
ture is  the  attraction  and  development  of 
superior  research  talent.  There  appear  to  be 
more  opportunities  than  qualified  people  to 
handle  them.  This  has  led  to  the  pirating  of 
good  men.  One  research  director  told  the  in- 
terviewers this:  “I  have  the  greatest  spy  ser- 
vice in  the  Western  Hemisphere.  We  scout 
people  all  the  time.  It’s  a dangerous  game  to 
play,  but  the  stakes  are  high.” 

The  survey  shows  clearly  that  many  acad- 
emic people  believe  the  NIH  has  done  an  ex- 
cellent job  of  handing  out  all  this  new  money 
without  directly  trespassing  on  the  freedom 
of  the  universities  to  do  research  when, 
where,  and  how  they  want.  There  is  a wide- 
spread feeling  that  the  NIH  deserves  recog- 
nition for  its  organization  genius,  particularly 
its  wisdom  in  setting  up  outside  study  groups 
to  pass  on  research  grants. 

Federal  funds  have  not,  however,  been  an 
unmixed  blessing  to  the  medical  schools. 

Several  thoughtful  persons  asked  the  in- 
terviewers this  pertinent  question:  Are  we 
relying  on  federal  research  budgets  to  keep 
the  medical  schools  going? 

So  much  for  a brief  look  at  some  of  the 
findings.  There  are  two  major  ones  that  I 
have  not  yet  mentioned:  the  status  of  basic 
research  and  the  need  for  better  relations  be- 
tween government  and  the  pharmaceutical 
industry.  They  seemed  to  me  to  deserve  ful- 
ler treatment. 

The  Status  of  Basic  Research 

One  of  the  important  findings  of  the  survey 
was  the  one  regarding  “basic  research,”  I 
mean  the  pursuit  of  new  scientific  knowledge 
for  its  own  sake,  with  no  advance  guarantee 
how  this  knowledge,  once  gained,  can  be  of 
use  in  treating  specific  diseases.  This  is  the 
way  research  scientists  believe  we  have  fash- 
ioned the  building  blocks  out  of  which  most 
significant  discoveries  in  every  field  have 
been  constructed. 

Unfortunately,  much  of  this  work  is  quite 


unspectacular  and  is  usually  invisible  to  the 
layman,  who  sees  only  the  final  culminating 
triumph,  like  Dr.  Salk’s  spectacular  vaccine. 
Most  laymen  are  interested  merely  in  useful 
end  products  and  with  research  pointed  di- 
rectly toward  such  products.  They  would 
agree  with  that  colorful  Washington  admin- 
istrator who  was  often  quoted  as  saying  that 
he  didn’t  believe  public  funds  should  be 
spent  to  find  out  what  makes  the  grass  green 
or  fried  potatoes  brown. 

The  survey  brought  out  quite  clearly  the 
firm  belief  that,  until  public  understanding 
and  attitudes  change.  Congress  will  never  ap- 
propriate more  than  a handful  of  dollars  for 
the  essential  task  of  pushing  back  the  fron- 
tiers of  knowledge  in  the  medical  and  bio- 
logical sciences.  Apparently,  if  we  want  to  do 
basic  research  as  a prerequisite  for  curing, 
alleviating,  or  preventing  disease,  we  shall 
have  to,  it  is  said,  engage  in  a kind  of  subter- 
fuge; we  shall  have  to  raise  money  from  the 
public  for  one  avowed  purpose  — to  fight 
cancer,  for  instance — and  give  it  to  the  scien- 
tists for  another  purpose,  such  as  fundamen- 
tal research  in  the  biochemistry  of  steroids, 
which  may  or  may  not  lead  to  a cancer  cure, 
or  a drug  for  arthritis,  or  for  something  else. 

The  result  has  been  a proliferation  of  In- 
stitutes of  Health  in  Bethesda,  each  one  ded- 
icated to  a different  category  of  disease,  or 
group  of  diseases,  such  as  the  National  Can- 
cer Institute,  with  an  appropriation  this  year 
of  $56  million,  the  National  Institute  of  Men- 
tal Health,  with  $40  million,  the  National 
Heart  Institute  with  $36  million,  and  so  forth. 
Down  at  the  bottom  of  the  list  is  a relatively 
small  item  labeled  “non-categorical  research.” 
Presumably  this  can  be  used  for  basic  re- 
search projects  that  cannot  be  squeezed  into 
the  definition  of  one  or  another  of  the  di- 
seases. 

Although  the  NIH  is  acutely  aware  of  this 
problem  and  has  worked  hard  to  alleviate  it, 
the  survey  showed  that  it  was  causing  great 
confusion  in  the  universities,  where  there 
were  widespread  complaints  that  basic  re- 
search was  being  starved.  One  medical 
school,  on  the  other  hand,  understands  the 
system  thoroughly.  It  has  a staff  man  who 
devotes  most  of  his  time  to  rewriting  all  the 
research  projects  his  institution  wants  to 
carry  out,  so  they  will  fit  into  one  disease 
category  or  another.  But  many  scientists  feel 


— 29  — 


SOUTH  DAKOTA 


uneasy  about  spending  public  money  when 
they  are  not  quite  sure  they  are  working 
toward  the  conquest  of  the  disease  for  which 
Congress  appropriated  funds. 

The  universities,  medical  schools,  and  re- 
search institutes  are  being  forced  to  go  along 
with  what  amounts  to  a fifth  of  a billion  dol- 
lar “wink”  in  order  to  be  able  to  carry  on 
basic  research  within  the  limits  imposed  by 
the  Congress.  The  implications  of  this  go 
beyond  the  realm  of  medicine;  they  reach 
down  to  the  roots  of  national  security,  which, 
in  our  age,  are  imbedded  in  science. 

The  Need  of  Frank  Support  For  Basic 
Research 

The  time  has  come  for  both  the  Adminis- 
tration and  the  Congress  to  face  up  to  the 
imperatives  of  science  — which  the  Soviet 
Union  has  apparently  learned  to  do.  High 
among  these  imperatives  is  frank  and  wide- 
spread support  for  basic  research. 

Sputnik  is  no  accident.  It  is  a warning 
against  the  general  notion  that  scientific  re- 
search needs  to  be  “useful”  to  deserve  our 
support.  This  is  a popular  delusion  that  can 
lure  us  off  the  road  to  survival. 

Let’s  stop  playing  a “shell  game”  with  basic 
research  in  the  medical  and  related  biological 
and  chemical  sciences.  Let’s  put  its  vital  ker- 
nel in  an  environment  where  it  will  grow,  and 
reproduce,  and  in  its  own  due  course  produce 
fruitful  results.  Let’s  recognize  frankly  that 
in  the  medical  field  this  type  of  research  is 
absolutely  essential  to  the  public  interest. 
Let’s  change  the  obsolete  method  of  appro- 
priations, under  which  basic  research  vital  to 
the  country  can  get  adequate  funds  only  by 
subterfuge. 

Let’s  face  the  fact  that  the  Federal  Gov- 
ernment, through  the  National  Institutes  of 
Health  and  the  National  Science  Foundation, 
must  finance  basic  medical  research  if  it’s  to 
be  done  to  the  extent  needed.  Most  of  it 
should  be  done  in  the  universities  and  non- 
profit organizations  because  most  of  the  best 
people  interested  in  basic  research  are  found 
there,  and  these  institutions  just  don’t  have 
the  funds  necessary  to  support  the  needed 
programs  themselves.  But  let’s  not  overlook 
the  many  excellent  research  scientists  who 
are  most  competent  in  basic  work  and  who 
are  now  employed  in  the  laboratories  of  pri- 
vate industry. 

Above  all,  let’s  use  all  our  persuasive  and 


other  abilities  with  the  general  public  and 
the  members  of  Congress  to  the  end  that  the 
Federal  Government’s  financial  support  of 
basic  medical  research  is  on  a far-sighted, 
long-term  and  broad-gauged  basis. 

Government-Industry  Relations 

This  brings  me  to  my  final  point  on  the 
survey  findings:  the  need  for  better  relations 
between  government  and  the  pharmaceutical 
industry.  The  survey  report  indicates  that 
both  groups  were  somewhat  critical  of  each 
other  during  the  interviews.  Each  was  a 
little  suspicious  of  the  other’s  motives,  poorly 
informed  about  what  he  was  up  to,  and  not 
too  sympathetic  with  his  problems.  This  is  a 
typical  picture  of  industry-government  rela- 
tions when  the  industry  is  new  to  Washington 
of  when  the  federal  government  makes  a 
significant  move  into  a new  area  of  activity. 

No  industry  is  more  associated  with  the 
public  interest  than  the  pharmaceutical  in- 
dustry, which  bears  a heavy  share  of  the 
burden  in  our  society  for  maintaining  and 
improving  the  health  of  the  American  people. 
In  view  of  this,  both  the  industry  and  the 
government,  in  my  opinion,  would  be  derelict 
in  their  duties  if  they  did  not  make  patient 
and  persistent  efforts  to  understand  one  an- 
other and  co-operate  closely  in  the  solution  of 
major  problems. 

Cancer  Research  Program 

One  time-honored  method  of  creating  closer 
understanding  is  to  bring  problems  out  into 
the  open  and  discuss  them  with  frankness  and 
with  a genuine  desire  to  reach  a meeting  of 
minds.  One  specific  problem  with  which  the 
industry  and  the  NIH  have  been  wrestling 
over  the  past  few  months  arises  because  of  a 
new  program  of  the  government  to  screen 
tens  of  thousands  of  chemical  compounds  for 
anti-cancer  activity.  Because  of  some  initial 
successes.  Congress  has  asked  the  NIH  to 
accelerate  the  program  drastically.  This  is 
being  done. 

The  next  step  was  to  work  out  an  agree- 
ment acceptable  to  the  firms  in  the  pharma- 
ceutical industry  willing  to  co-operate.  These 
firms  are  needed  because  of  their  unique 
ability  to  create  entirely  new  chemical  com- 
pounds by  the  thousands,  or  to  produce  old 
ones  in  adequate  quantities  for  extensive 
testing  purposes.  When  we  started  working 
on  this  problem,  we  immediately  ran  head  on 
into  an  entirely  new  problem.  Simply  stated, 


— 30  — 


JANUARY  1958 


it  is  this:  Suppose  this  program,  supported  by 
government  funds,  comes  up  with  a preven- 
tive, an  effective  treatment  or  a cure  for  one 
of  the  many  types  of  cancer,  say  leukemia. 
Who,  then,  will  produce  and  distribute  the 
new  drug?  Under  what  conditions? 

The  responsible  officials  in  the  Department 
of  Health,  Education,  and  Walfare  have 
shown  skill,  imagination,  and  courage  in  fac- 
ing up  to  this  one.  They  have  devised  a 
proposal  that,  in  my  opinion,  is  a workable 
solution  to  the  problem  of  how  to  recognize 
private  rights  and  at  the  same  time  safeguard 
the  public  interest.  In  essence,  if  the  new 
screening  program  results  in  a marketable 
drug,  the  company  that  made  the  successful 
compound  will  have  the  initial  responsibility 
for  manufacture  and  distribution.  On  the 
other  hand,  the  product  must  be  sold  royalty- 
free  to  the  government  for  its  own  needs  and 
the  producer  must  assure  a supply  of  the 
new  drug  adequate  to  the  public’s  needs.  If 
the  company  fails  to  live  up  to  its  side  of  this 
bargain,  the  Surgeon  General  of  the  United 
States  Public  Health  Service  has  what  are 
called  “march-in”  rights.  That  is,  he  can 
march  in  and  force  compulsory  licensing  of 
the  product. 

So  far,  so  good.  But  this  is  merely  a be- 
ginning. We  are  talking  about  a drug  for 
leukemia,  remember.  Can  you  imagine  the 
public  excitement  this  would  create?  Stop 
for  a moment  and  picture  what  it  would  be 
like  if  your  own  son  or  daughter  were  under 
sentence  of  death  with  leukemia.  Even 
though  you  are  trained  as  a physician  to  be 
most  cautious  about  the  early  claims  for  a 
new  remedy,  when  would  you  want  this  drug 
for  your  child?  How  about  the  many  parents 
who  don’t  understand  why  they  should  be 
patient? 

Production  of  a New  Drug 

The  manufacturer  who  had  made  the  com- 
pound would  be  under  enormous  pressure. 
Once  the  new  drug  had  been  approved  by 
the  Food  and  Drug  Administration,  he  would 
be  expected  to  produce  enough  of  it  to  satisfy 
the  national  demand  almost  immediately.  If 
I seem  to  overstate  the  case,  ask  yourselves 
this:  How  many  people  this  autumn  thought 
they  ought  to  be  able  to  get  protection  against 
Asian  flu  within  only  a few  weeks  of  the 
time  this  new  virus  was  isolated  for  the  first 
time? 


Now,  let  us  see  whether  we  can  define  some 
of  the  questions  that  would  arise  at  the  time 
of  our  hypothetical  drug  for  leukemia,  keep- 
ing in  mind  the  emotional  atmosphere  within 
which  we  would  have  to  work  out  the  an- 
swers. And  let  me  say  parenthetically  that 
no  one  — least  of  all  I — has  adequate  an- 
swers. In  fact,  there  has  been  little  more 
than  the  most  casual  thinking  about  the  prob- 
lem even  among  the  hundred  or  so  leaders 
of  medical  research  who  were  interviewed 
during  our  survey.  It  is  the  hope  of  stimula- 
ting a little  overdue  thinking  and  public  dis- 
cussion of  the  problem  that  I raise  it  with  you 
today. 

First,  let  us  look  at  the  problems  from  the 
point  of  view  of  the  government,  specifically 
from  that  of  the  Surgeon  General,  for  it  will 
be  on  him  that  all  the  public  impatience  will 
be  focused.  How  is  he  going  to  decide 
whether  or  when  to  exercise  his  march-in 
rights?  Should  he  insist  that  the  company 
that  discovered  the  compound  must  license 
its  competitors,  so  that  there  will  be  several 
alternative  sources  of  supply?  If  so,  how 
many?  Should  he  do  this,  even  though  it  is 
quite  clear  that  the  first  company  alone  can 
produce  enough  to  satisfy  national  demand 
just  as  soon  as  an  additional  three  or  four 
would  be  able  to  do  it?  Suppose  the  Surgeon 
General  does  march  in,  which  of  the  many 
interested  competitors  should  be  licensed  and 
on  what  basis. 

Now  let  us  turn  over  the  coin  and  look  at 
the  problem  from  the  point  of  view  of  the 
manufacturer  who  discovered  the  compound. 
This  pharmaceutical  company  probably  was 
able  to  make  the  compound  in  the  first  place 
because  of  years  of  experience  with  related 
chemicals.  It  may  have  been  investing  sev- 
eral hundred  thousand  research  dollars  an- 
nually on  this  group  of  chemicals  over  a long 
period  of  time  without,  as  yet,  any  financial 
reward.  Now,  as  part  of  the  joint  industry- 
government  program,  it  has  finally  uncovered 
a useful  product  that  promises  a return  on 
these  years  of  investment. 

First,  the  company  builds  a pilot  plant  to 
make  enough  of  the  compound  for  extensive 
nation-wide  tests  and  to  learn  how  to  manu- 
facture it  on  a large  scale.  It  drafts  plans  for 
the  building  of  a mass  production  plant,  in 
case  the  tests  prove  successful.  Suppose  they 
are  successful,  but,  before  a patent  is  issued, 


— 31  — 


SOUTH  DAKOTA 


other  manufacturers,  not  burdened  by  years 
of  research,  testing,  and  pilot  production,  de- 
cide to  move  in  to  share  the  few  remaining 
risks,  and,  incidentally,  the  prospects  of  more 
substantial  monetary  rewards.  Things  like 
this  happen  often  in  this  highly  competitive 
industry.  Will  the  creator  of  the  compound 
then  be  forced  to  license  those  adventurers, 
willy-nilly,  for  fear  of  public  criticism  or  be- 
cause the  Surgeon  General,  under  the  glare 
of  public  impatience,  might  exercise  his 
march-in  rights? 

Public  Impatience  And  Industry  Output 

It  looks  as  if  we  can  trace  many  of  these 
problems  back  to  public  impatience.  The  con- 
fusion this  creates  can  be  eliminated  only  by 
better  information,  more  understanding,  and 
time.  For  the  enormous  productivity  of  the 
American  pharmaceutical  industry  can  al- 
ways be  counted  upon  to  meet  the  demand, 
given  a reasonable  amount  of  time.  This  is 
the  way  it  worked  out  with  penicillin,  and, 
after  that,  with  streptomycin,  cortisone,  and 
Salk  vaccine.  This  is  what  we  see  happening 
in  the  case  of  Asian  flu  vaccine,  too,  and  with- 
in a very  few  weeks.  The  six  manufacturers 
of  Asian  flu  vaccine  have  already  produced 
over  27,000,000  doses  up  through  last  October 
23.  Merck,  alone,  produced  and  got  gov- 
ernment clearance  for  3,000,000  doses  from 
Monday  through  Friday  of  last  week,  a new 
record  that  we  expect  to  better  in  succeeding 
weeks. 

This  fine  accomplishment  was  made  pos- 
sible by  the  far-sighted  planning  of  Surgeon 
General  Burney  and  his  staff,  by  the  team- 
work of  the  federal  government  and  our  own 
scientists,  and  by  production  people  in  indus- 
try, who  worked  night  and  day,  seven  days  a 
week.  Those  of  us  closest  to  the  situation 
feel  a deep  sense  of  gratitude  toward  these 
men  and  women  who  isolated  this  new  flu 
virus,  developed  a vaccine,  tested  it  for  safety 
and  effectiveness,  set  up  specifications, 
worked  out  a mass  production  process,  and 
got  us  up  to  the  present  level  of  output  — all 
within  less  than  five  months. 

The  flu  vaccine  experience  is  a good  ex- 
ample of  what  the  pharmaceutical  industry 
can  do  in  a short  time.  The  general  public 
must  be  made  to  understand,  however,  that 
even  in  a leukemia  situation  it  takes  some 
time  to  produce  the  quantities  needed.  I sub- 
mit that  it  would  not  be  in  the  public  interest. 


and  in  fact  would  be  harmful,  to  take  the 
production  responsibility  away  from  the 
manufacturer  or  manufacturers  who  make 
the  initial  “breakthrough,”  even  if  the  prod- 
uct involved  is  for  the  treatment  of  some 
form  of  cancer. 

Drug  Distribution  Question 

One  more  question:  distribution.  This  will 
arise  most  clearly  if,  instead  of  a treatment 
or  a cure  for,  let’s  say  leukemia,  the  govern- 
ment screening  program  comes  up  with  a 
preventive.  This  might  be  a vaccine  that, 
after  proper  testing,  most  doctors  would  con- 
clude should  be  given  to  all  children  in  a cer- 
tain age  group.  Should  we  then  go  outside 
the  normal  drug  distribution  channels,  and 
have  the  government  purchase  supplies  to  be 
injected  on  a mass  scale  through  public  health 
agencies? 

I should  like  to  raise  two  questions  about 
such  a policy.  First,  is  it  sensible  to  bypass 
the  wisdom  and  skill  of  our  200,000  physicians 
and  their  judgment  about  what  would  be  best 
for  their  individual  patients?  Will  we  gain 
as  much  as  we  will  lose  as  a result  of  what 
would,  in  effect,  be  a mass  prescription?  Sec- 
ond, how  about  the  desirability  of  ignoring 
our  vast  and  efficient  drug  distribution  net- 
work? Its  cornerstone  is  that  small  business- 
man, the  local  druggist,  who  is  able  to  fill  any 
one  of  a thousand  prescriptions  on  a few 
minutes’  notice,  any  time  of  day  or  night. 

Quite  clearly,  in  my  opinion,  we  should  use 
to  their  full  advantage  the  great  skills  and 
resources  of  the  pharmacists,  wholesale  drug- 
gists, the  people  in  the  manufacturers’ 
branches,  and,  above  all,  our  trained  phys- 
icians in  distributing  and  using  any  new  med- 
icine or  drug,  whether  it  be  a preventive  or 
a treatment. 

Conclusion 

I realize  that  this  has  been  a rather  lengthy 
discussion.  Perhaps  I can  bring  it  back  into 
focus  by  offering  the  major  recommendation 
that,  it  seems  to  me,  flows  directly  from  the 
survey.  It  is  this: 

Let  us  do  whatever  needs  to  be  done  to 
get  wide  public  recognition  of  the  vital  need 
for  basic  research  in  the  medical  field  so 
that  Congress  no  longer  has  to  play  a “shell 
game”  when  appropriating  funds  for  this  pur- 
pose. This  is  the  only  sure  way  to  make  the 
kind  of  progress  toward  the  conquest  of  di- 
(Continued  on  Page  36) 


— 32  — 


YOUR  OFFICE,  DOCTOR,  is  the  “cancer  detection  center”  which  we  urge  all  adults 
to  visit  once  a year,  and  where  early  diagnosis  of  cancer  can  help  save  many  thou- 
I sands  of  lives.  It  is  upon  you  that  we  largely  rely  for  the  carrying  out  of  many 
aspects  of  our  education,  research  and  service  programs.  As  members  of  our  Boards 
of  Directors  — on  the  National,  Division  and  Unit  levels  — it  is  your  thinking  and 
your  guidance  which  are  such  vital  factors  in  creating  and  executing  our  policies 
and  programs. 

You,  of  course,  are  concerned  with  all  the  ills  affecting  the  human  body.  The 
American  Cancer  Society  deals  specifically  with  cancer.  But  our  mutual  concern  — 
the  tie  that  binds  us  inextricably— is  the  saving  of  human  lives.  Through  your  efforts, 
we  may  soon  say~“one  out  of  every  two  cancer  patients  is  being  saved.”  Indeed, 

^ with  your  help,  cancer  will  one  day  no  longer  be  a major  threat. 

Ik 


ROMILAR  CF  CAPSULES 
Description:  Romilar  CF  (Romilar  Cold 
Formula)  is  a multiple-action  medication 
for  relief  of  the  discomforts  of  colds  and 
other  acute  upper  respiratory  disorders. 
Introduced  recently  in  syrup  form,  it  is 
now  also  available  in  capsules.  Each  cap- 
sule provides:  Romilar  Hydrobromide  (non- 
narcotic antitussive)  15  mg.,  Clorphenira- 
mine  maleate  (antihistamine)  1.25  mg.. 
Phenylephrine  hydrochloride  (decongest- 
ant) 5 mg.,  and  N-acetyl-p-aminophenol 
(analgesic-antipyretic)  120  mg. 

Indications:  Each  of  the  active  ingredients  in 
Romilar  CF  contributes  to  the  relief  of  one 
or  more  of  the  most  frequently  encountered 
symptoms  of  colds.  Romilar  is  a non- 
narcotic cough  specific.  Chlorpheniramine 
relieves  allergic  manifestations  of  the  res- 
piratory tract  by  antihistaminic  action. 
Phenylephrine  is  a sympathomimetic  agent, 
orally  effective  in  reducing  nasal  and  bron- 
chial congestion.  N-acetyl-p-aminophenol 
provides  analgesic  and  antipyretic  effects. 

Romilar  capsules  are  indicated  in  the  re- 
lief of  cough,  excessive  secretions,  conges- 
tion, fever,  headache  and  myalgia  asso- 
ciated with  respiratory  disorders,  such  as 
coryza,  influenza,  rhinitis,  sinusitis,  pharyn- 
gitis, tracheitis,  bronchitis,  laryngitis,  asth- 
ma, grippe  and  pneumonitis. 

Dosage:  Adults  and  older  children  — one  to 
two  capsules  every  four  hours;  children 
8-12  years  — one  capsule  every  four  hours. 
Dosage  Form:  Bottles  of  100. 

Source:  Roche  Laboratories. 

TRICOFURON  IMPROVED  VAGINAL 
SUPPOSITORIES  AND  POWDER 
Description:  Tricofuron  Vaginal  Supposi- 
tories Improved  contain  Furoxone,  brand  of 
furazolidone : N -(5-nitro~2-f urf urylidene)-3- 


amino-2-oxazolidone  0.25%,  and  Micofur, 
brand  of  nifuroxime:  anti  5-nitro-2-furald- 
oxime  0.375%,  in  a watermiscible  base 
which  melts  at  body  temperature.  Trico- 
furon Vaginal  Powder  Improved  contains 
Furoxone  0.1%  and  Micofur  0.525%  in  a 
powder  base  composed  of  dextrose,  lactose, 
citric  acid  and  cornstarch. 

Indications:  Furoxone  is  a specific  tricho- 
monacide;  Micofur  is  a fungicide  highly 
effective  against  Candida  (Monilia)  albi- 
cans. Furoxone  and  Micofur  are  nitrofur- 
ans  — different  from  antibiotics  and  sul- 
fonamides. 

Dosage  Forms:  Suppository  of  2 Gm.,  her- 
metically sealed  in  green  foil,  in  box  of  12. 
Powder  is  plastic  insufflator  of  15  Gm. 
with  3 disposable  tips,  and  glass  bottle  of 
30  Gm. 

Source:  Eaton  Laboratories,  Norwich,  N.  Y. 

ZACTIRIN 

Description:  A potent,  non-narcotic  analgesic 
containing  the  new  chemical  compound, 
ethoheptazine.  Each  distinctive  yellow  and 
green  Zactirin  tablet  contains  75  mg.  etho- 
heptazine citrate  (yellow  layer)  and  5 gr. 
acetylsalicylic  acid  (green  layer). 

Indications:  Zactirin  has  been  found  particu- 
larly effective  in  the  relief  of  low  back  pain 
and  pain  of  minor  traumatic  injuries,  joint 
pains  and  related  disorders  (arthritis,  bur- 
sitis, neuralgia,  synovitis,  etc.),  abdominal, 
perineal,  and  menstrual  pains,  and  post- 
operative and  dental  pains.  It  is  non- 
addicting and  does  not  have  any  of  co- 
deines’ undesirable  side  effects. 

Dosage:  For  moderate  to  moderately  severe 
pain,  2 Zactirin  tablets,  3 or  4 times  daily, 
is  the  suggested  routine  dose.  For  mild 
pain,  1 Zactirin  tablet  3 or  4 times  daily, 
may  suffice.  The  total  daily  dosage  should 


34  — 


JANUARY  1958 


not  exceed  8 tablets. 

Dosage  Form:  Tablets,  bottles  of  48. 

Source:  Wyeth  Laboratories. 

LEVOPHED  0.02% 

Description:  A new  dosage  form  of  the  potent 
vasoconstrictor  Levophed  (levarterenol) 
containing  0.02%  of  the  drug. 

Indications:  For  emergency  use  specifically 
as  an  intravenous  or  intracardiac  injection 
in  cases  of  sudden  heart  standstill. 

Dosage:  Heart  beat  has  been  restored  in  some 
cases  through  an  injection  of  from  one-half 
to  three-quarters  cc.  of  the  solution,  un- 
diluted. The  drug  is  injected  intravenously 
and  massaged  toward  the  heart.  If  the 
heart  beat  is  not  restored  almost  immed- 
iately, the  chest  is  opened  for  manrol  mas- 
sage. During  massage  a second  injection  of 
Levophed  into  the  right  ventricle  may  be 
given. 

Dosage  Form;  Two  cc.  ampuls  Levophed  is 
also  supplied  in  4 cc.  ampuls  of  0.2%  solu- 
tion which  are  administered  by  intraven- 
ous diffusion  after  dilution  to  1000  cc.  with 
5%  dextrose  solution. 

Source:  Winthrop  Laboratories. 

SUL-SPANTAB 

Description:  Sustained  release  tablets  of 
0.65  gm.  sulfaethylthiadiazole. 

Indications:  Indicated  in  the  treatment  of  a 
wide  range  of  respiratory,  urinary  and 
other  infections. 

Dosage:  In  severe  infections,  three  tablets 
every  twelve  hours,  in  all  urinary  tract  in- 
fections and  moderate  infections,  two  tab- 
lets every  twelve  hours;  in  prophylaxis, 
one  tablet  every  twelve  hours.  The  initial 
dose  should  be  twice  the  maintenance  dose. 

In  children  up  to  75  lbs.  the  companion 
preparation  Sul-Spansion  Liquid  should  be 
used. 

Dosage  Form:  Bottles  of  50  tablets  — Sul- 
Spansion  Liquid  in  8 fluid  oz.  bottles. 
Source:  Smith,  Kline  and  French. 

KANAMYCIN 

The  new  Japanese  antibiotic  kanamycin, 
reported  experimentally  effective  against 
tuberculosis  and  other  infections,  is  being 
produced  by  Bristol  Laboratories  for  clinical 
trial  in  the  United  States. 

Kanamycin  was  described  in  November  by 
its  discoverer.  Dr.  Hamao  Umezawa  of  Tokyo 
University  and  Japan’s  National  Institute  of 
Health,  in  an  address  before  the  Pasteur  Fer- 


mentation Centennial  held  at  the  Waldorf- 
Astoria  Hotel  by  Charles  Pfizer  & Co. 

Dr.  Umezawa  told  scientists  attending  the 
Centennial  that  preliminary  tests  had  shown 
kanamycin  to  be  less  toxic  than  either  neo- 
mycin or  streptomycin,  the  latter  of  which  is 
the  standard  antibiotic  now  used  in  tuber- 
culosis. 

The  Japanese  scientist  reported  that  in  ad- 
dition to  protecting  animals  against  tuber- 
culosis germs  resistant  to  other  drugs,  kana- 
mycin provided  protection  against  infection 
with  staphylococcus,  pneumococcus  (pneu- 
monia), and  typhoid  bacteria.  He  also  dis- 
cussed other  antibiotics  isolated  in  his  Tokyo 
laboratories,  which  are  credited  with  a large 
number  of  antibiotic  discoveries. 

In  announcing  U.  S.  production,  of  kana- 
mycin for  test  purposes,  Bristol  Laboratories 
noted  that  Dr.  Umezawa’s  comments  on  the 
new  antibiotic  were  based  on  tests  conducted 
in  Japan.  Kanamycin  is  at  present  under  in- 
tensive U.  S.  clinical  investigation  for  the 
treatment  of  a number  of  diseases. 

DARTAL  TABLETS 

Description:  Dartal  dihydrochloride  is  a new, 
single  chemical  substance,  with  the  generic 
name  of  thiopropazate  dihydrochloride  and 
the  chemical  description  of  l-(2-acetoxye- 
t h y 1 ) - 4 - [3-(2-chloro-10-phenothiazinyl)pro- 
pyljpiperazine  dihydrochloride. 

Indications:  On  low  dosages  Dartal  produces 
tranquilizing  effects  without  sedation  in  the 
following  disorders:  agitated  and  anxiety 
states  associated  with  insomnia,  anorexia, 
abnormal  excitement,  the  psychosomatic 
symptoms  of  organic  disorders  such  as  pep- 
tic ulcer,  cerebral  arteriosclerosis,  catatonic 
or  paranoid  schizophrenia,  neuroses,  psy- 
choses, acute  mania,  Huntington’s  chorea, 
barbiturate  addiction  and  alcoholism. 
Dosage:  The  recommended  dosage  for  anxiety 
tension  states,  psychosomatic  disorders  and 
other  neurosis  is  5 mg.  three  times  daily, 
and  for  psychotic  conditions  it  is  10  mg. 
three  times  daily.  These  respective  dosages 
should  be  individually  adjusted  upward  or 
downward,  according  to  the  needs  and  re- 
sponse of  the  patient,  in  units  of  5 or  10 
mg.  at  intervals  of  three  or  four  days. 
Dosage  Form:  Tablets,  5 mg.,  bottles  of  50  and 
500  and  Tablets,  10  mg.,  bottles  of  50  and 
500. 

Source:  G.  D.  Searle  and  Company. 


— 35  — 


SOUTH  DAKOTA 


THE  PRESCRIPTION  PHARMACIST 
TODAY— 

(Continued  from  Page  26) 
cent  are  “very  well”  satisfied,  and  another  49 
per  cent  are  “fairly  well”  satisfied.  Moreover, 
most  of  the  pharmacists  are  optimistic  about 
their  financial  futures.  Only  22  per  cent 
expect  to  be  making  under  $7,500  five  years 
from  now,  while  62  per  cent  expect  to  be 
making  more  than  that  amount.  The  other 
16  per  cent  either  will  be  retired  in  five  years 
or  don’t  choose  to  make  a prediction  so  far 
in  advance. 


THE  NEW  ERA  IN  MEDICAL  RESEARCH— 

(Continued  from  Page  32) 
sease  that  the  American  people  expect. 

One  last  word.  Let  us  remember,  as  we 
think  about  some  of  these  problems,  that  I 
have  plucked  them  out  of  their  context  in 
order  to  get  an  objective  look  at  them  for 
policy  considerations.  Now  for  a moment  I 
would  like  to  ask  you  to  put  them  back.  You 
will  see  that  what  I have  been  talking  about, 
really,  are  better  ways  to  avert  human  suf- 
fering and  death,  not  just  for  those  other 
people  in  the  morbidity  and  mortality  tables, 
but  for  your  wife  and  mine,  your  children 
and  mine;  maybe  for  you  and  for  me. 


mams  //ymm 

INSURANCE  COMPANY  OF  IOWA 


MARKS  ANOTHER  YEAR 

In  Our  MutualAssociation 

For  Progress  Together 

1958  As  we  at  Druggists'  Mutual  look  forward  to  our  'half-century'  milestone  next  year, 
_ are  able  to  point  with  satisfaction  to  the  many,  many  policyholders  we  have 

I VDO  served  over  our  49  years  as  a specialized  druggists'  and  professional  men's  insurance 

1958  company. 

_ In  fact,  there  are  literally  hundreds  of  splendid  drug  store  establishments  who  have 

I ✓ JO  been  'with  us'  over  these  years. 

1958  So  as  the  year  1958  unfolds,  we  at  Druggists'  Mutual  renew  our  pledge  to  supply 
_ you  with  efficient  insurance  protection,  coupled  with  welcome  dividend  savings  and 

I yjO  the  personal  type  of  service  that  has  always  called  to  mind:  "Druggists'  Mutual". 

HOME  OFFICES 
ALGONA,  IOWA 


All  Policies  Non-Assessable 


— 36  — 


PHARMACY 


PROFESSIONAL 
FRATERNITY  CHAPTER 
BEING  ORGANIZED  AT 
STATE  COLLEGE 

A chapter  of  the  Kappa  Psi 
Pharmaceutical  Fraternity  is 
being  organized  by  students 
of  the  Division  of  Pharmacy, 
South  Dakota  State  College. 
Kappa  Psi  is  one  of  the  na- 
tional professional  frater- 
nities in  pharmacy.  Currently 
there  are  forty-nine  col- 
legiate chapters,  twenty-two 
graduate  chapters  and  a 
membership  of  over  twenty 
thousand  pharmacists  and 
pharmacy  students. 

Charter  members  of  the 
State  College  chapter  are 
Donald  A.  Christopherson, 
Bath;  Harold  L.  Doeden,  Ful- 
da, Minn.;  Merlin  R.  Juene- 
man,  Adrian,  Minn.;  Richard 
M.  King,  Rapid  City;  Larry 
B.  Leighton,  Rutland;  Nor- 
val  G.  Luke,  Brookings;  An- 
ton E.  Melin,  St.  Paul,  Minn.; 
Paul  E.  Noll,  Aberdeen;  Cor- 
nelius C.  O’Hearn,  Worthing- 
ton, Minn.;  Vernon  Olson, 
Brookings;  Glenn  R.  Reecy, 
Brewster,  Minn.;  Richard  L. 
Robbins,  Howard;  Jim  W. 
Roemen,  Rock  Rapids,  Iowa; 
Stanley  M.  Shaw,  Parkston; 
Darryl  D.  Steering,  Water- 
ville,  Minn.;  James  A.  Thor- 
son,  Brookings;  John  R.  Ul- 
stad,  Brookings;  Kenneth  W. 


Urquhart,  Brookings;  Jack 
D.  Winder,  Britton;  Dean 
Floyd  J.  LeBlanc;  Professor 
Clark  T.  Eidsmoe;  and  Pro- 
fessor Guilford  C.  Gross. 

Also,  present  members  of 
Kappa  Psi  who  are  sponsor- 
ing the  organization  of  the 
chapter  are  Jack  Vesely, 
Junior  pharmacy  student 
from  Algonquin,  Illinois,  and 
Professors  Harold  Bailey, 
Kenneth  Redman  and  Ner- 
val Webb.  Dr.  Webb  has 
been  selected  as  faculty  ad- 
visor to  the  new  group. 

Founded  in  1879,  the  or- 
ganization was  at  first  a joint 
medical-pharmaceutical  fra- 
ternity with  chapters  being 
chartered  in  both  medical 
and  pharmacy  schools  and 
colleges.  In  1924,  by  mutual 
agreement,  members  of  both 
professions  decided  that  the 
Fraternity  should  separate 
into  two  distinct  organiza- 
tions, one  for  the  medical 
students  and  one  for  the 
pharmacy  students.  The 
pharmacy  division  retained 
the  name  “Kappa  Psi”  and 
the  medical  division  adopted 
the  name  “Theta  Kappa  Psi.” 

In  announcing  the  organ- 
ization of  the  chapter  at 
State  College,  Dr.  Webb  said, 
“We  feel  that  the  establish- 
ment of  a chapter  of  Kappa 
Psi  at  the  Division  of  Phar- 


macy, South  Dakota  State 
College  will  bring  about 
closer  professional  relation- 
ships among  the  men  en- 
rolled in  pharmacy.  The  ob- 
jectives of  the  fraternity  in- 
clude the  support  and  active 
participation  in  all  projects 
which  will  advance  the  pro- 
fession and  the  development 
of  industry,  sobriety  and  fel- 
lowship among  pharmacy 
students  while  fostering  high 
ideals,  scholarship  and  phar- 
maceutical research.” 


LUNSFORD 
RICHARDSON 
PHARMACY  AWARDS 

The  Vick  Chemical  Com- 
pany has  announced  that 
applications  may  be  made 
for  the  Lunsford  Richardson 
Pharmacy  Awards  for  senior 
and  graduate  students  in 
pharmacy. 

Eight  $500  awards  and  six- 
teen $100  awards  will  be 
given  to  senior  and  graduate 
students  of  pharmacy  in  each 
of  four  different  regions  of 
the  United  States  for  the  best 
papers  on  any  of  the  selected 
subjects  listed. 

Cash  awards  of  equal 
amounts  will  be  given  to 
schools  attended  by  winning 
students  in  each  region. 


— 37  — 


SOUTH  DAKOTA 


Honorable  mention  awards 
of  $100  each  will  be  made  to 
two  undergraduate  and  two 
graduate  students  in  each  of 
four  regions  who  submit  the 
next  best  papers. 

The  awards  were  estab- 
lished in  honor  of  Lunsford 
Richardson  (1854-1919),  foun- 
der of  the  Vick  Chemical 
Company,  and  his  son  Luns- 
ford (1891-1953),  who  became 
President  and  later  Chair- 
man of  the  Board  of  Direc- 
tors of  the  Company.  The 
winners  of  the  awards  will 
be  announced  about  June  1, 
1958. 

The  purpose  of  the  Luns- 
ford Richardson  Pharmacy 
Awards  is  to  encourage  and 
stimulate  the  senior  and 
graduate  student: 

1.  To  explore  and  investi- 
gate current  problems  of 
pharmacy. 

2.  To  summarize  and  pre- 
sent their  findings  for  the 
benefit  of  other  students  and 
investigators. 

3.  To  broaden  the  scope  of 
their  interest  in  the  profes- 
sion of  pharmacy. 

Students  may  submit  a 
paper  on  one  of  the  following 
subjects: 

UNDERGRADUATES 

What  can  L as  a phar- 
macist, do  to  practice  and  to 
promote  pharmaceutical 
ethics?  This  subject  may  in- 
clude a part  or  all  of  the  fol- 
lowing topics  or  related 
topics  not  included  here  .... 
extent  and  use  of  the  phar- 
macisfs  professional  knowl- 
edge; the  pharmacist’s  obli- 
gation to  recruit  students  in- 
to pharmacy;  membership, 
participation,  and  responsi- 
bility in  organization  activ- 
ities; duty  to  compound  and 
dispense  prescriptions  as 
written;  need  for  cooperating 


with  colleagues  and  censur- 
ing unethical  practices. 

How  can  I,  as  a pharmacist, 
improve  my  professional 
status  as  a member  of  the 
health  team?  This  subject 
may  include  a part  of  all  of 
the  following  topics  or  re- 
lated topics  not  included 
here  ....  working  with  the 
allied  health  professions  (re- 
fusal to  prescribe,  to  diag- 
nose, or  to  discuss  therapeu- 
tic effect  of  the  prescription 
with  patients,  unfair  pres- 
cription pricing);  participat- 
ing in  programs  to  inform 
the  public  of  health  needs 
and  disease  control;  and 
helping  local  agencies  to  en- 
fore  laws  related  to  health 
and  sanitation. 

GRADUATES 

Any  paper  submitted  as  a 
thesis  or  a portion  thereof  in 
partial  fulfillment  of  the  re- 
quirements leading  to  a grad- 
uate degree  in  Pharmaceu- 
tical Chemistry,  Pharma- 
cology, Pharmacognosy, 
Pharmacy,  or  Pharmaceu- 
tical Administration;  or  a 
paper  written  on  the  basis  of 
original  research. 

All  manuscripts  will  be 
considered  by  the  judges  on 
the  basis  of:  (1)  New  thoughts, 
concepts  or  ideas  pertaining 
to  the  subject  selected.  (2) 
Originality  of  viewpoint  of 
the  material  submitted  and 
its  appropriations.  (3)  Clar- 
ity of  expression  and  effec- 
tive arrangement  of  material 
presented. 

The  following  judges,  each 
prominent  in  the  field  of 
pharmacy,  will  impartially 
select  the  prize-winning 
manuscripts:  Undergraduate 
Papers  — George  F.  Archam- 
bault,  D.Sc.,  Past  President, 
American  Society  of  Hos- 
pital Pharmacists;  Madeline 


Oxford  Holland,  D.Sc.,  Ed- 
itor, American  Professional 
Pharmacist;  Thomas  D. 
Rowe,  Ph.D.,  Dean,  College 
of  Pharmacy,  University  of 
Michigan.  Graduate  Papers 
— Samuel  W.  Goldstein, 
Ph.D.,  Director,  American 
Pharmaceutical  Association 
Laboratory;  Melvin  W. 
Green,  Ph.D.,  Director  of 
Educational  Relations,  Amer- 
ican Council  on  Pharmaceu- 
tical Education;  and  Louis  C. 
Zopf,  D.Sc.,  Dean,  College  of 
Pharmacy,  State  University 
of  Iowa. 

PHARMASCOOPS 

Ray  Mazourek  formerly 
manager  of  the  Danks  Phar- 
macy at  Lake  Andes  has  ac- 
cepted a position  as  adminis- 
trator of  the  hospital  at  Wag- 
ner, South  Dakota.  The 
Danks  Pharmacy  was  closed 
December  1 as  a Registered 
Pharmacy  and  will  be  oper- 
ated by  Mrs.  Danks  in  the 
future  as  the  Danks  Sundry 
Store. 

The  Canistota  Drug  Store 
has  been  sold  to  Gerald 
Smith.  Mr.  Smith  formerly 
managed  the  Sioux  Valley 
Hospital  Pharmacy  and  had 
owned  stores  at  Hecla  and 
Veblen.  Bob  Meyer  will 
assist  in  the  management  of 
the  pharmacy. 

The  Sioux  Falls  Pharma- 
ceutical Association  held  its 
regular  monthly  meeting 
Nov.  13  at  the  Y.M.C.A. 
Among  other  topics  brought 
up  was  a Christmas  Party 
which  would  include  hus- 
bands, wives,  and  dates.  Also 
discussed  was  the  giving  of 
Copies  between  Drug  Stores. 
Pat  Lind  was  elected  Treas- 
urer. The  Association  will 
now  meet  regularly  on  the 
[ second  Wed.  of  each  month. 


— 38  — 


S.D.J.O.M.  JANUARY  1958  - ADV. 


21 


• debilitated 

• elderly 

• diabetics 

• infants,  especially  prematures 

• those  on  corticoids 

• those  who  developed  moniliasis  on  previous 
broad-spectrum  therapy 

• those  on  prolonged  and/or 
high  antibiotic  dosage 

• women— especially  if  pregnant  or  diabetic 


the  best  broad-spectrum  antibiotic  to  use  is 


MYSTECLIN-V 

Squibb  Tetracycline  Phosphate  Complex  (Sumycin)  and  Nystatin  (Mycostatin)  Sumycin  plus  Mycostatin 

for  practical  purposes,  Mysteciin-V  is  sodium-free 


i 

I 


Capsules  (250  mgr./250,000  u.),  bottles 
of  16  and  100.  Half-Strength  Capsules 
(125  mg./125,000  u.).  bottles  of  16 
and  100.  Suspension  (125  mg’./125,000 
u.),  2 02.  bottles.  Pediatric  Drops  (lOO 
in?./100,000  u.),  10  cc.  dropper  bottles. 


Squibb 

m 


Squibb  Quality— 
the  Priceless  Ingredient 


for  “built-in”  safety,  Mysteclin -V  combines: 

1.  Tetracycline  phosphate  complex  (Sumycin)  for  superior 
initial  tetracycline  blood  levels,  assuring  fast  transport  of 
adequate  tetracycline  to  the  infection  site. 

2.  Mycostatin— the  first  safe  antifungal  antibiotic— for  its 
specific  antimonilial  activity.  Mycostatin  protects 

many  patients  (see  above)  w'ho  are  particularly  prone  to  monilial 
complications  when  on  broad-spectrum  therapy. 


MYSTECLIN-V  PREVENTS  MONILIAL  OVERGROWTH 


25  PATIENTS  ON 

TETRACYCLINE  ALONE 

25  PATIENTS  ON 

TETRACYCLINE  PLUS  MYCOSTATIN 

Before  therapy 

After  seven  days 
of  therapy 

Before  therapy 

After  seven  days 
of  therapy 

« # # ® # 

• « « • « 

♦ # ® ® 

• • • • 

• • • # • 

• » # • • 

# « @ ® @ 

• • • • • 

• • # » 0 

« • ® • • 

• • • o • 

e • • ^ • 

» » • # # 

• • • • • 

• • • • • 

• • • • • 

• • • • • 

Monilial  overgrowth  (rectal  swab)  S None  S Scanty  S Heavy 

Childs,  A.  J.:  British  M.  J.  1:660  1956. 


•MYSTECLIN, ••  'MYCOSTATIN AND  •SUMYCIN' 


<aOEMARKS 


why  Oiihetaneis  the  best  reason  yet  for  you  to  re-examine 
the  antihistamine  you’re  now  using  »Milligram  for  milligram, 


DIMETANE  potency  is  unexcelled,  dimetane  has  a therapeutic  index  unrivaled  by  an] 
other  antihistamine— a relative  safety  unexceeded 
by  any  other  antihistamine,  dimetane,  even  in  very 
low  dosage,  has  been  effective  when  other  antihis- 
tamines have  failed.  Drowsiness,  other  side  effects 
have  been  at  the  very  minimum. 


» unexcelled  antihistaminic  action 


Diagnosis 

No.  of 
Patients 

Response 

Side  Effects  II 

Excellent 

Good 

Fair 

Negative 

Allergic 

rhinitis  and  vaso* 
motor  rhinitis 

30 

14 

9 

5 

2 

Slight  Drowsiness  (3)  ■ 

Urticaria  and 
angioneurotic 
edema 

3 

t 

I 

I 

Dizzy  (1)  1 

Allergic 

dermatitis 

2 

1 

1 

Slight  Drowsiness  (2)  1 

Bronchial  aslhma 

1 

1 

Pruritus 

I 

1 

Total 

37 

15 

13 

7 

2 

Drowsiness  (5)  w W 
Dizzy  (1) 

Dimetaj^^xteMab^ludie^Hhre^nvesUgators^^rlhei^Iinicannvesti^lion^il^^reporledascompI^ 


OIMETANE  IS  PARABROMDYLAMINE  MALEATE  - EXTENTABS  12  MG., TABLETS  4 MG.,  ELIXIR  2 MG.  PER  5 CC. 


I blanket  of  allergic  protection,  covering  10-12 
lours  — with  just  one  Dimetane  Extentab  »dimetane 
iJxtentahs  protect  patient  for  10-12  hours  on  ons  tablet. 

Periods  of  stress  can  be  easily  han- 
dled with  supplementary  DIMETANE 
Tablets  or  Elixir  to  obtain  maxi- 
mum coverage. 

A.  H.  ROBINS  CO.,  INC. 


Dosage: 

Adults— One  or  two  i-mg.  tabs, 
or  two  to  four  teaspoonfuls 
Elixir,  three  or  four  times  daily. 
One  Extentab  q.8-12  h. 

or  twice  daily. 
Children  over  6— One  tab, 
or  two  teaspoonfuls  Elixir  t.i.d. 
or  q.i.d.,  or  one  Extentab  q.l2h. 

Children  S-6—V2  tab. 
or  one  teaspoonful  Elixir  t.i.d. 


Richmond,  Virginia  | Ethical  Pharmaceuticals  of  Merit  Since  1878 


14 


Reviews  of  ataraxic  therapy  commonly  divide  the  available  tranquilizers  into  three 
main  categories:  the  rauwolfia  derivatives;  the  phenothiazine  compounds;  and  a 
smaller  group  of  agents  which  are  lumped  together  for  the  sake  of  convenience 
rather  than  because  of  any  common  characteristic. 


As  a result,  one  significant  fact  is  often  overlooked:  ATARAX  (hydroxyzine)  does 
not  fit  into  any  of  these  three  categories.  Indeed,  by  any  logical  criterion,  it 
belongs  in  a class  by  itself. 


1.  ATARAX  is  chemically  unique.  It  differs  from  any  other  tranquilizer  now  avail- 
able, not  in  minor  molecular  rearrangements  but  in  basic  structure. 


2.  ATARAX  is  therapeutically  different.  ATARAX  is  characterized  by  unique  cerebral 
specificity.  On  ATARAX,  the  patient  retains  full  consciousness  of  incoming  stimuli 
—their  nature  and  their  intensity-but  his  reactions  are  those  of  a well-adjusted 
person.  He  is  neither  depressed  nor  torpid,  and  his  reflexes  remain  normal,  as  does 
cortical  function.  Thus  ATARAX  induces  a calming  peace-of-mind  effect  without 
disturbing  mental  alertness. 


3.  ATARAX  is,  perhaps,  the  safest  ataraxic  known.  It  is  outstandingly  well  tolerated. 
Every  clinical  report  confirms  this  fact.*  After  more  than  150  million  doses,  there 
has  not  been  a single  report  of  toxicity,  blood  dyscrasia,  parkinsonian  effect,  liver 
damage,  or  habituation. 


4.  ATARAX  is  unusually  flexible.  This  lack  of  toxicity  makes  it  possible  to  adjust 
ATARAX  dosage  to  virtually  any  patient  need.  In  the  lowest  range,  children  respond 
well  to  10  mg.  or  one  teaspoonful  of  syrup  t.i.d.,  while  anxious  adults  usually  are 
treated  with  25  mg.  q.i.d.  Yet,  if  needed,  the  dosage  can  safely  be  raised:  in  more 
severe  disturbances,  dosages  up  to  1,000  mg.  daily  have  been  administered  without 
adverse  reactions. 


In  reviewing  your  own  experience  with  tranquilizers,  remember  that  ATARAX  is  in 
a class  by  itself;  that  you  cannot  judge  it  by  your  results  with  any  other  drug.  To  get 
to  know  ATARAX  at  first  hand,  prescribe  it  for  the  next  four  weeks  whenever  a 
tranquilizer  is  indicated.  See  for  yourself  how  it  compares. 


‘Documentation  on  request 


ATARAX 


pe;ice  OF  MIND  ;it;ir;ix' 


(brand  of  hydroxyzine) 


in  any 

hyperemotive 

state 


for  childhood  behavior  disorders 

10  mg.  tablets— 3-6  years,  one  tab- 
let t.i.d.;  over  6 years,  two  tablets 
t.i.d.  Syrup— 3-6  years,  one  tsp. 
t.i.d.;  over  6 years,  two  tsp.  t.i.d. 

for  adult  tension  and  anxiety 

25  mg.  tablets -one  tablet  q.i.d. 
Syrup— one  tbsp,  q.i.d. 


Medical  Director 


for  severe  emotional  disturbances 

100  mg.  tablets— one  tablet  t.l.d. 


for  adult  psychiatric  and  emotional 
emergencies 

Parenteral  Solution— 25-50  mg. 
(1-2  cc.)  intramuscularly,  3-4 
times  daily,  at  4-hour  intervals. 
Dosage  for  children  under  12  not 
established. 


Supplied;  Tablets,  bottles  of  100.  Syrup, 
pint  bottles.  Parenteral  Solution,  10  cc. 


New  York  17,  New  York 
Division,  Chas.  Pfizer  & Co.,  Inc. 


■ Relieves  cough  quickly  and  thor- 
oughly ■ Effect  lasts  six  hours  and 
longer,  permitting  a comfortable 
night’s  sleep  ■ Controls  useless 
cough  without  impairing  expecto- 
ration ■ rarely  causes  constipation 

■ And  pleasant  to  take 


Syrup  and  oral  tablets.  Each  teaspoon- 
ful or  tablet  of  Hycodan*  contains  5 mg. 
dihydrocodeinone  bitartrate  and  1.5  mg. 
Mesopin.t  Average  adult  dose;  One  tea- 
spoonful or  tablet  after  meals  and  at 
bedtime.  May  be  habit-forming.  Avail- 
able on  your  prescription. 


26 


S.D.J.O.M.  JANUARY  1958  - ADV. 


THESE  DIETS  CAN 

HEEP  YOU  MANAGE 
YOUR  PATIENTS  WITH 


i *ou» 
» i''' 


\j»e  orAi 


Cl6»«Tl 


tevet»»«  “ 


’ Calorie 
diet 


ont 

c^txxn.  r 
4«ee«‘' 


youTSj  *«d  of  foorf 

Pic»»oj 

“^‘‘•eeJoaed 
^•■wbefr.es 


brojhj 

. »rtoiW 

»i7& T™"  xw 


Upon  your  request,  The 
Armour  Laboratories  will 
be  pleased  to  send  you  a 
complimentary  supply  of 
1800  and  2400  calorie  diets 
. . . low  in  carbohydrate  and 
high  in  unsaturated  fats  . . . 
intended  for  use  in  conjunc- 
tion with  ARCOFAC,  the 
Armour  preparation 
designed  to  lower  elevated 
blood  cholesterol. 


Arcofac  need  be 

taken  only  once  a day  . . . 
in  relatively  small 
amounts  . . . and  allows 
the  patient  to  eat 
a balanced,  nutritious 
and  palatable  diet. 


Each  tablespoonful  of 
ARCOFAC  emulsion 
contains: 

Linoleic  acid*.  . . . 6.8  Gm. 

Vitamin  Be 0.6  mg. 

Mixed  tocopherols 

(Vitamin  E) . . . . 11.5  mg. 

*derived  from  safflower  oil  which 
contains  the  highest  concentra- 
tion of  unsaturated  fatty  acids 
of  any  commercially  available 
vegetable  oil. 


Arcofac 


is  available 


in  bottles  of  12  fluid  ounces. 


THE  ARMOUR 


LABORATORIES 


A DIVISION  OF  ARMOUR  AND  COMPANY  • KANKAKEE,  ILLINOIS 


S.D.J.O.M.  JANUARY  1958  - ADV. 


27 


Ask  to  see  the  new 


WELCH  ALLYN 


No.  777  "Professional" 

FLASHLIGHT 


A Better  Case  for 
Better  Instruments  by 

WELCH  ALLYN 

This  is  Welch  Allyn’s  new  No.  23  polyethy- 
lene one  piece  molded  case  for  otoscope-ophthal- 
moscope sets.  Can  be  washed  or  sterilized  with 
standard  germicides,  extremely  compact  and 
practically  indestructible.  Holds  Welch  Allyn 
operating  or  diagnostic  otoscope  attached  to 
medium  battery  handle  ready  for  use,  plus  any 
WA  ophthalmoscope  head,  spare  lamps  and  5 
otoscope  specula.  Available  separately  for  use 
with  existing  Welch  Allyn  sets  with  medium 
handle  or  as  part  of  complete  new  sets. 

No.  23  Polyethylene  Cose  only $5.00 

KREISER’S  INC. 

SURGICAL  DIVISION 

Minnesota  Ave.  & 21st  St.  Sioux  Falls 


When  anxiety  and  tension  "erupts”  in  the  G.  I.  tract. . . 

in  spastic 
and  irritabie  coion 


PATHIBAMATE 

Meprobamate  with  PATHILON®  Lederle 

Combines  Mcprobamat©  {400  mg.)  the  most  widely  prescribed  tranquilizer. . . helps  control  the 
“emotional  overlay”  of  spastic  and  irritable  colon — without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . with  PATHILON  {25  mg.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 

•Trademark  ® Registered  Trademark  for  Tridihexethyl  Iodide  Lederle 

LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER.  NEW  YORK 


28 


S.DJ.O.M.  JANUARY  1958  - ADV. 


both- 


NEW 

ISUPREL 


orally  for 

dependable  prophylaxis- 
sublingually  for 
fast  relief 


S.D.J.O.M.  JANUARY  1958  - ADV. 


29 


FRANOt"' 


ASTHMATIC- 

but  cheerful  instead  of  fearful 

New  Isuprel-Franol  tablets  bring 
round-the-clock  relief  plus  emergency 
help  against  sudden  attack.  Anxiety 
stops  when  patients  know  they’ll  get 
relief  in  60  seconds  — relief  that  con- 
tinues for  four  hours  or  more. 

Isuprel  HCl  (10  mg.  for  adults,  5 mg. 
for  children) , the  most  potent  broncho- 
dilator  known,  makes  up  the  outer 
coating.  In  a sudden  attack,  the  patient 
puts  the  tablet  under  his  tongue.  Relief 
starts  in  60  seconds.  A unique  feature 
is  the  “flavor-timer.”  As  the  Isuprel  is 
absorbed  a lemon  flavor  appears.  When 
it  disappears — about  five  minutes  later 
— the  patient  swallows  the  tablet. 

An  unexcelled  combination  for  pro- 
longed bronchodilatation  makes  up  the 
Isuprel-Franol  core:  benzylephedrine 
HCl  (32  mg.).  Luminal®  (8  mg.)  and 
theophylline  (130  mg.) . Swallowed,  the 
tablet  works  for  four  hours  or  more. 

Isuprel-Franol  tablets  are  “. . . effec- 
tive in  controlling  over  80%  of 
patients  with  mild  to  moderate 
attacks  of  asthma.”^ 

1.  Fromer,  J.  L..  and  DeRisio, 

V.  J. : Lakey  Clin.  Bull.  10 :45, 

Oct.-Dcc.,  1956. 


LABORATORIES 
New  York  18,  N.  Y. 


ISUPREL-FRANOL 

tablets  (Isuprel  HCl  10  mg.) 
for  adults; 

ISUPREL-FRANOL 

Mild  tablets  (isuprel  HCl 
5 mg.)  for  children: 

One  tablet  every  three  or 
four  hours  taken  orally  for 
continuous  control  of  bron- 
chospasm  in  chronic  asthma. 
One  tablet  taken  sublingual- 
ly for  sudden  attack.  “Fla- 
vor-timer” signals  when 
patient  should  swallow. 
Bottles  of  100  tablets. 


*‘Flavor-timer'*  signals  patients 
when  to  swallow  tablets 


ISUPREL 

Immediate  effect  sublingually- 
for  emergency  use 


LEMON  “FLAVOR-TIMER" 

Disappearance  of  flavor  is  the 
signal  to  swallow 

( Theophylline 
FRANOL  J Luminal 

( Benzylephedrine 
Sustained  action  — reduces  fre- 
quency and  intensity  of  attacks 


ISUPREL  (BRAND  OF  ISOPROTERENOL),  FRANOL  AND  LUMINAL  (BRAND  OF  PH  ENOB  ARBI  T AL) , TRADEMARKS  REG.  U.  S.  PAT.  OFF. 


30 


S.D.J.O.M.  JANUARY  1958  -ADV. 


See  anybody  here  you  know,  Doctor? 


Fm  just  too  much 


AM  PLUS’ 


for  sound  obesity  management 

dextro-amphetamine  plus  vitamins 
and  minerals 


Fm  too  little 


STIMAVITE’ 

stimulates  appetite  and  growth 

vitamins  Bi,  Be,  B12,  C and  L-lysine 


I’m  simply  two 


OBRON® 

a nutritional  buildup  for  the  OB  patient 

OBRON® 

HEMATINIC 

when  anemia  complicates  pregnancy 


And  I’m  getting  brittle 


rm 


NEOBON^ 

5-factor  geriatric  formula 

hormonal,  hematinic  and 
nutritional  support 


With  my  anemia, 
Fll  never  make  it  up 
that  high 


ROETINIC 

one  capsule  a day,  for  all  treatable  anemias 

HEPTUNA®  PLUS 

when  more  than  a hematinic  is  indicated 


solve  their  problems  with  a nutrition  product  from 


(Prescription  information  on  request) 


New  York  17,  New  York 
Division,  Chas.  Pfizer  & Co.,  Inc, 


S.D.J.O.M.  JANUARY  1958  - ADV. 


31 


I 

1 


ANNUAL  CLINICAL  CONFERENCE 

CHICAGO  MEDICAL  SOCIETY 

MARCH  4,  5,  6 and  7, 1958 
Palmer  House,  Chicago 

Daily  Half-Hour  Lectures  by  Outstanding  Teachers  and  Speakers  on  subjects  of  interest  to  both 
general  practitioner  and  specialist 

Panels  on  Timely  Topics  Daily  Teaching  Demonstrations 

Scientific  Exhibits  worthy  of  real  study  and  helpful  and  time-saving  Technical  Exhibits 

Medical  Color  Telecasts 

The  Chicago  Medical  Society  Annual  Clinical  Conference  should  be  a MUST  on 
the  calendar  of  every  physician.  Plan  now  to  attend  and  make  your  reservations 
at  the  Palmer  House. 


when  anxiety  and  tension  "erupts”  in  the  G.  I.  tract... 

IN  DUODENAL  ULCER 


PATH  I BAM  ATE' 

Meprobamate  with  PATHILON®  Lederle 

Combines  Meprobamate  {^00  the  most  widely  prescribed  tranquilizer  . . . helps  control 
the  “emotional  overlay”  of  duodenal  ulcer  — without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . .with  PATHILON  {25  Tng.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 

•Trademark  ® Registered  Trademark  for  Tridihexefhyl  Iodide  Lederle 

LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 


32 


S.D.J.O.M.  JANUARY  1958  - ADV. 


For  Speedier  Return  To  Normal  Nutrition 


and  the  Protein  Need 


in  Renal  Disease 


opinion  holds  that  during  the  nephrotic 


state — provided  the  kidneys  are  capable  of  excreting 
nitrogen  in  a normal  manner — the  patient  should  be 
given  a diet  high  in  protein  (1.5  to  2 grams  per  kilogram 
of  body  weight  daily) . The  purpose  of  such  a diet  is  to 
replace  depleted  plasma  protein  and  to  increase  the 
colloidal  osmotic  pressure  of  the  blood. 

Sharp  restriction  of  dietary  salt  appears  indicated 
only  in  the  presence  of  edema,  but  moderate  restriction 
is  usually  recommended. 

Lean  meat  is  admirably  suited  for  the  diets  pre- 
scribed in  most  forms  of  renal  disease.  It  supplies  rela- 
tively large  amounts  of  high  quality  protein  and  only 
small  amounts  of  sodium  and  chloride.  Each  100  Gm. 
of  unsalted  cooked  lean  meat  (except  brined  or  smoked 
types)  provides  approximately  30  Gm.  of  protein,  and 
only  about  100  mg.  of  sodium  and  75  mg.  of  chloride. 

In  addition  to  its  nutritional  contributions  meat 
fulfills  another  advantageous  purpose:  It  helps  make 
meals  attractive  and  tasty  for  the  patient  who  must 
rigidly  adhere  to  a restricted  dietary  regimen. 


The  nutritional  statements  made  in  this  advertisement 
have  been  reviewed  by  the  Council  on  Foods  and  Nutri- 
tion of  the  American  Medical  Association  and  found 
consistent  with  current  authoritative  medical  opinion. 


American  Meat  Institute 

Main  Office,  Chicago  . . . Members  Throughout  the  United  States 


S.D.J.O.M.  JANUARY  1958  - ADV. 


33 


. . . and  may  we 
remind  you  that 
a glass  of  beer 
can  make  high 
protein  diets 
more  palatable? 


The  High 

Protein  Diet 


Meat,  of  course,  is  an  outstanding  source  of 
protein,  but  it  can  easily  be  reinforced  with 
other  protein  foods.  For  instance,  a fluffy 
omelet  folded  over  penny-sliced  frankfurters, 
ground  cooked  meat,  flaked  fish  or  cheese  is 
both  tempting  and  economical. 

A green  salad  topped  generously  with  shoe- 
strings of  meat  and  cheese  carries  its  weight  in 


protein.  Cottage  cheese  for  extra  protein  is 
especially  tasty  in  a salad  or  as  a spread  on 
dark  bread.  An  egg  white  whipped  into  fruit 
juice  makes  a frothy  flip— and  fruit  and  cheese 
for  dessert  give  a big  protein  boost.  For 
variety’s  sake  a frosty  glass  of  beer*  adds  zest 
to  any  meal  as  well  as  protein  to  the  diet. 

^Protein  0.8  Gm.;  Calories  104/8  oz.  glass  (Average  of  American  Beers) 


United  States  Brewers  Foundation 

Beer — America’s  Beverage  of  Moderation 


If  you’d  like  reprints  of  12  different  diets,  please  write  United  States  Brewers  Foundation,  535  Fifth  Avenue,  New  York  17,  N.  Y. 


34 


S.D.J.O.M.  JANUARY  1958  - ADV. 


respiratory 


relief  in  minutes 


congestion 
. . lasts  for 


(!ra[ly 

hours 


In  the  common  cold,  nasal  allergies,  sinus- 
itis, and  postnasal  drip,  one  timed-release 
Triaminic  tablet  brings  welcome  relief  of 
symptoms  in  minutes.  Running  noses  stop, 
clogged  noses  open — and  stay  open  for  6 to 
8 hours.  The  patient  can  breathe  again. 

With  topical  decongestants,  “unfortu- 
nately, the  period  of  decongestion  is  often 
followed  by  a phase  of  secondary  reaction 
during  which  the  congestion  may  be  equal 
to,  if  not  greater  than,  the  original  condi- 
tion. . . The  patient  then  must  reapply 
the  medication  and  the  vicious  cycle  is 
repeated,  resulting  in  local  overtreatment, 
pathological  changes  in  nasal  mucosa,  and 
frequently  “nose  drop  addiction.” 

Triaminic  does  not  cause  secondary  con- 
gestion, eliminates  local  overtreatment  and 
consequent  nasal  pathology. 

•Morrison,  L.  F.;  Arch.  Otolaryng.  59:48-53  (Jan.)  1954. 

Each  double-dose  “timed-release”  triaminic 

Tablet  contains: 

Phenylpropanolamine  hydrochloride  50  mg. 


Pyrilamine  maleate 25  mg. 

Pheniramine  maleate 25  mg. 


Dosage:  1 tablet  in  the  morning,  afternoon,  and 
in  the  evening  if  needed. 


Each  double-dose  *‘timed-release** 
tablet  keeps  nasal  passages 
clear  for  6 to  8 hours — 
provides  *‘around-the-clock** 
freedom  from  congestion  on 
just  three  tablets  a day 


disintegrates  to  give  3 to  4 
more  hours  of  relief 


Also  available;  Triaminic  Syrup,  for  children  and 
those  adults  who  prefer  a liquid  medication. 


Triaminic 


timed-release" 

tablets 


running  noses . . 


0''n>d  open  stuffed  noses  orally 


SMITH-DORSEY  . a division  of  The  Wander  Company  . Lincoln,  Nebraska  • Peterborough,  Canada 


n6W  for  angina 


ATARA)& 


(PEKTACftYTHRITOL  TETRAfUTRATE)  <KrOROXV2INt) 


links 

freedom  from 
anginal  attacks 


with  a shelter  of 
tranquility 


In  pain.  Anxious.  Fearful.  On  the  road  to  cardiac 
invalidism.  These  are  the  pathways  of 
angina  patients.  For  fear  and  pain  are  inexorably 
linked  in  the  angina  syndrome. 


New  York  17,  New  York 

Division,  Chas.  Pfizer  if  Co.,  Inc. 


For  angina  patients —perhaps,  the  next  one  who 
enters  your  office— won’t  you  consider  new 
CARTRAx?  This  doubly  effective  therapy  combines 
PETN  (pentaerythritol  tetranitrate)  for  lasting 
vasodilation  and  atarax  for  peace  of  mind. 

Thus  CARTRAX  relieves  not  only  the  anginal  pain 
but  reduces  the  concomitant  anxiety. 

Dosage  and  supplied:  begin  with  1 to  2 yellow  cartrax 
“10”  tablets  (10  mg.  petn  plus  10  mg.  atarax)  3 to  4 times 
daily.  When  indicated,  this  may  be  increased  for  more 
optimal  effect  by  switching  to  pink  cartrax  “20”  tablets 
(20  mg.  PETN  plus  10  mg.  atarax.)  For  convenience,  write 
“cartrax  10”  or  “cartrax  20.”  In  bottles  of  100. 
cartrax  should  be  taken  30  to  60  minutes  before  meals,  on 
a continuous  dosage  schedule.  Use  petn  preparations 
with  caution  in  glaucoma. 

“Cardiac  patients  who  show  significant  manifestations  of 
anxiety  should  receive  ataractic  treatment  as  part  of  the 
therapeutic  approach  to  the  cardiac  problem."^ 

1.  Waldman,  S.,  and  Pelner,  L.:  Am.  Pract.  & Digest  Treat.  5:1075  (July)  1957. 
•trademark 


36 

S.D.J.O.M.  JANUARY  1958  - ADV. 

FROM  THE  GRAY  FLANNELS 

Twin  gold  medals  citing  the  laboratory  and 
physician  which  have  done  the  most  during 
the  year  to  further  public  health  in  Mexico 
have  been  awarded  to  Mead  Johnson  de 
Mexico,  S.  A.,  and  the  founder  of  the  Mexican 
Academy  of  surgery,  Dr.  Jose  Aguilar  Al- 
varez. 

EVERY  WOMAN 

The  pharmaceutical  house  and  Dr.  Alvarez 
were  the  first  to  win  these  new  annual 
awards,  known  as  the  Dr.  Jimenez  medals, 
of  the  Fundacion  Medico-Farmaceutica.  Presi- 

WHO  SUFFERS 

dent  Ruiz  Cortines  of  Mexico  made  the  pre- 
sentations to  A.  J.  Torrey,  president  of  Mead 
Johnson  de  Mexico,  an  dthe  physician  at  an 

IN  THE 

awards  dinner  this  month  (November)  in 
Mexico  City. 

MENOPAUSE 

. DESERVES 

A new  synthetic  corticosteroid  hormone 
with  greater  potency  and  with  less  tendency 
to  produce  undesirable  side  effects  is  now 
available  to  the  medical  profession,  it  was 

"premarin: 

announced  by  The  Upjohn  Company. 

A derivative  of  prednisolone,  indications 

widely  used 

for  the  new  steroid  are  the  same  as  those 
for  the  parent  compound.  These  include 
rheumatic  diseases,  allergic  diseases,  general- 

natural^  oral 

ized  dermatoses  with  an  allergic  component, 
acute  occular  inflammatory  disease  and  other 
diseases  responsive  to  anti-inflammatory  cor- 
ticosteroids such  as  adrenogenital  syndrome, 
nephrosis,  ulcerative  colitis  and  leukemia. 

estrogen 

Chronic  constipation  was  successfully  alle- 
viated and  a return  to  normal  bowel  habits 
initiated  by  a new  combination  of  a peristal- 
tic stimulant  and  a stool  softener  in  70  per 
cent  of  patients  included  in  a recent  clinical 
study. 

The  study,  conducted  by  Dr.  A.  Compton 
Broders,  Jr.  of  the  Scott  and  White  Clinic, 
Temple,  Tex.,  was  reported  in  the  American 
Journal  of  Digestive  Diseases. 

The  new  agent  is  Peri-Colace,  a synergistic 
combination  of  Colace  (dioctyl  sodium  sul- 
fosuccinate.  Mead  Johnson)  and  Peristim 
(purified  and  standardized  glycosides  of  cas- 
cara.  Mead  Johraon). 

AYERST  LABORATORIES 

New  York,  N.  Y.  • Montreal,  Canada 

5645 

S.D.J.O.M.  JANUARY  1958  -ADV. 


37 


How  +o  wiv^ 'friends  ... 


The  Best  Tasting  Aspirin  you  can  prescribe. 

The  Flavor  Remains  Stable  down  to  the  last  tablet. 
25^  Bottle  of  48  tablets  (IM  grs.  each). 


We  will  be  pleased  to  send  samples  on  request. 

THE  BAY  EH  COMPANY  DIVISION 

of  sterling  Drug  Inc. 

1450  Broadway,  New  York  18,  N.  Y. 


S.D.J.O.M.  JANUARY  1958  - ADY. 


in  bronchial  asthma  and  respiratory  allergies 


specify  the  buffered  ‘‘predni-steroids” 
to  minimize  gastric  distress 


I 


combined  steroid-antacid  therapy . . 


‘Co-Deltra’  or  ‘Co-Hydel- 
tra’  provides  all  the  bene- 
fits of  “predni-steroid” 
therapy  and  minimizes  the 
likelihood  of  gastric  distress 
which  might  otherwise  im- 
pede therapy.  They  provide 
easier  breathing — and 
smoother  control — in  bron- 
chial asthma  or  stubborn 
respiratory  allergies. 

SUPPLIED:  Multiple  Compressed 
Tablets  ‘Co-Deltra’  or  ‘Co-Hy- 
deltra’  in  bottles  of  30,  100,  and 
500. 


Multiple 

Compressed 

Tablets 


2.5  mg.  or  5.0  mg. 
of  prednisone  or 
prednisolone,  plus 
300  mg.  of  dried 
aluminum 
hydroxide 
gel  and  50  mg. 
of  magnesium 
trisilicate. 


(Prednisone  buffered) 


(Prednisolone  buffered) 


MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  ft  CO..  INC. 
PHILADELPHIA  J.  PA. 


•CO-DELTRA’  and  ’CO-HYDELTRA’  are 
reoislered  trademarks  of  Merck  & Co..  iNC. 


S.D.J.O.M.  JANUARY  1958  - ADV. 


39 


“WRAP  UP” 


DOESN'T  COST... 


Sales  and  Profits 


December  is  a busy  month  for  pharmacists.  In  addition  to  the 
Christmas  merchandising  rush,  more  prescriptions  are  filled  in 
December  than  in  any  other  month  of  the  year.  One  particular 
item  you  will  find  enjoying  unprecedented  demand  this  month 
is  a relatively  new  prescription  leader — ‘V-Cillin  K.’* 

Ask  our  salesman  to  check  your  stock  of  ‘V-Cillin  K’  regularly 
so  that  you  can  wrap  up  every  sale  with  a minimum  of  incon- 
venience. For  quick,  dependable  service,  send  your  orders  to  us. 


*‘V-Cillin  K’  (Penicillin  V Potassium,  Lilly) 


WE 


ARE  A 


DISTRIBUTOR 


BROWN  DRUG  COMPANY 


Sioux  Falls,  South  Dakota 


when  anxiety  and  tension  "erupts” in  the  G.  I.  tract... 

IN  GASTRIC  ULCER 

PATHIBAMATE 

Meprobamate  with  PATHILON®  Lederle 

Combines  Meprobamate  {400  mg.)  the  most  widely  prescribed  tranquilizer  . . . helps  control 
the  “emotional  overlay”  of  gastric  ulcer without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . "With  PATH  ILON  (25  mg^  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 

•Trademark  ® Registered  Trademark  for  Tridihexethyl  Iodide  Lederle 

LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY.  PEARL  RIVER.  NEW  YORK 


40 


S.DJ.O.M.  JANUARY  1958  - ADV. 


ysi 

POLYSPORIN- 


brand 

POLYMYXIN  B-BACITRACIN  OINTMENT 


^ kdm  h/mji-^beSmc 


'hUfUm(0Ky 


For  topical  use:  in  V%  oz.  and  1 oz.  tubes. 
For  ophthalmic  use:  in  '/«  oz.  tubes. 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  Tuckahoe,  N.  V. 


S.D.J.O.M.  JANUARY  1958  - ADV. 


41 


I 


To  cut  daytime  lethargy 
(and  j^rauwolfia  potency) 
in  treatment 
of  hypertension: 


Additional  clinical  evidence'  supports 
the  view  that  Harmonyl  offers  full 
rauwolfia  potency  coupled  with  much 
i less  lethargy.  In  a new  comparative 
: study  Harmonyl  was  given  at  the 
same  dosage  as  reserpine  and  other 
rauwolfia  alkaloids.  Only  one 
Harmonyl  patient  in  20  showed 
lethargy,  while  11  patients  in  20 
showed  lethargy  with 

reserpine;  10  in  20  with  OLB-frott 

the  alseroxylon  fraction. 


for  your  hypertensives 
who  must  stay  on  the  job 

Harmonyl 

whife  the  drug  works  effettivefy  . . , 
so  does  the  patient 

•Trademark  for  Deserpidifie,  Abbott 

1.  Comparative  Effects  of  Various  Rauwolfia  Alka- 
loids in  Hypertension;  subm/tfed  for  publication. 


NO  WAITIN 


cuihulative 


response  to 
reserpine  alone 


in  anxiety  and  hypertension 
NEW  fast-acting 

®®Harmonyl-N- 

{Harmonyl*  and  NembutalX) 

Calmer  days,  more  restful  nights  starting  first  day 
of  treatment,  through  synergistic  action  of 
Harmonyl  (Deserpidine,  Abbott)  and  Nembutal 
(Pentobarbital,  Abbott).  Lower  therapeutic 
doses,  lower  incidence  of  side  effects.  Each 
Harmonyl-N  Filmtab  contains  30  mg.  Nembutal 
Calcium  and  0.25  mg.  Harmonyl.  Each 
Harmonyl-N  Half-Strength  Filmtab  combines 
15  mg.  Nembutal  Calcium  and 
0.1  mg.  Harmonyl. 


(SFilmtab-film-sealed  tablets,  Abbott;  pat.  applied  lor 


eoloeo 


’Trademark 


FROM  THE  GRAY  FLANNELS 

Dr.  Benjamin  W.  Carey  ha.s  been  appointed 
to  the  new  post  of  medical  director  of  Lederle 
Laboratories  Division,  American  Cyanamid 
Company.  He  was  previously  director  of  re- 
search laboratories  at  Pearl  River,  N.  Y. 

* * * 

A new  approach  in  educational  television 
was  unveiled  today  at  the  premiere  showing 
of  a series  of  13  medical  programs  produced 
under  a public  service  grant  from  Sobering 
Corporation.  The  series,  entitled  “World  of 
Medicine,”  is  the  first  of  a new  plan  where 
private  industry  is  helping  to  endow  educa- 
tional T.V.  The  first  T.V.  showing  will  be  on 
WTTW  Chicago  and  followed  by  presentation 
on  30  other  educational  stations. 

* * 

Kenneth  G.  Kohlstaedt,  M.D.,  director  of 
the  Lilly  Laboratories  for  Clinical  Research, 
has  been  elected  a vice-president  of  the 
American  Heart  Association.  The  election 
took  place  during  the  Association’s  Annual 
meeting,  held  October  25-29  in  Chicago. 

* * * 

Russell  E.  Schuster  has  been  promoted  to 
purchasing  agent  for  the  William  S.  Merrill 
Company,  Cincinnati. 


Clinical  Norms,  a compact  but  comprehen- 
sive book  useful  in  medical  practice  and  in 
professional  schools,  is  being  made  available 
by  Lakeside  Laboratories,  Inc.  on  request 
from  medical  school  deans  and  instructors  of 
clinical  nursing. 

In  its  27  pages,  the  publication  includes 
hundreds  of  facts  used  in  evaluations  of  lab- 
oratory tests  and  clinical  diagnoses  of  various 
conditions. 

Several  pages  are  devoted  to  blood,  includ- 
ing characteristics,  elements  and  constituents, 
as  well  as  hormones  and  vitamins.  Other  sec- 
tions deal  with  liver  function,  urine,  kidney 
function,  the  gastrointestinal  tract,  the  res- 
piratory system,  the  nervous  system,  endoc- 
rine system  and  reproductive  system.  Ped- 
iatrics and  genetics  are  two  more  important 
sections. 


S.D.J.O.M.  JANUARY  1958  - ADV. 


43 


SupevioT  for  acne  cleansing 


\ The  greatest  benefit  in 
; acne  therapy  comes  to 
‘ those  patients  who  use 
pHisoHex®  often  and 
,!  daily  in  conjunction 
‘ with  other  standard 
^ measures. 

For  best  results,  pre- 
scribe from  four  to  six 
pHisoHex  washings  of 
i the  acne  area  daily. 

pHisoHex  cleans  better 
; than  soap,  degerms  rap- 
idly, prevents  bacterial 
growth,  and  maintains 
normal  skin  pH. 


pHlsoHex* 

Sudsing, 
mnalkaline 
antibacterial 
detergent — 
nonirritating, 
hypoallergenic. 
Contains  3% 
hexachlorophene. 


LABORATORIES 
New  York  18,  N.Y. 


pHisoHeXj  trademark  reg.  U.  S.  Pat.  Off. 


More  direct  control  of 
specific  rheumatic  types 


IIP  Effective,  fast  anti-rheumatic  activity  without 
experimentation — that’s  the  simple  truth  about  P-B- 
SAL-C  (Ulmer)  combinations  which  have  been  dem- 
onstrated in  a wide  range  of  rheumatic  diseases. 

Relief  is  not  only  fast,  but  is  sustained  on  small 
daily  dosage.  Specially  fabricated  combinations  of 
P-B-SAL-C  provide  a choice  in  specific  rheumatic 
disorders.  In  severe  joint  pain  (particularly  in  persons 
over  40,  say  leading  medical  authorities) , P-B-SAL-C 
with  COLCHICINE  can  be  used  diagnostically  to 
ascertain  or  disprove  a gouty  condition.  Colchicine 
is  specific  for  the  diagnosis  and  control  of  gout. 

And  for  muscular  spasm  associated  with  severe 
joint  pain,  P-B-SAL-C  WITH  ESOPRINE  provides 
a two-way  action  to  help  control  both  pain  and  spasm. 

Where  arthritis  is  complicated  by  cardiovascular 
conditions,  P-B-SAL-C  SODIUM  FREE  brings  relief 
without  disturbing  electrolyte  balance.  Neither  so- 
dium nor  potassium  are  contained  in  this  combination. 

In  routine  therapy,  high  plasma  salicylate  levels 
are  quickly  reached  with  the  basic  combination, 
P-B-SAL-C. 

Whichever  P-B-SAL-C  combination  is  prescribed, 
you’re  assured  that  thousands  of  patients  have  ex- 
perienced rapid  relief  and  sustained  it  at  a very  moder- 
ate cost.  Let  us  forward  your  name  to  our  nearest 
detail  man  for  complete  information. 

P-B-SAL-C 

( U LiVI  E R) 


THE  ULMER  PHARMilCAL  COMPANY 

MINNEAPOLIS  3,  MINNESOTA 


44 


S.D.J.O.M.  JANUARY  1958  -ADV. 


SUSPENSION  \% 


no  sting 

no  smear 

no  cross 
contamination 


...Just  drop  on  eye ...  spreads  in  a wink!  Provides  unsur- 
passed antibiotic  efficacy  in  a wide  range  of  common  eye 
infections ...  dependable  prophylaxis  following  removal  of 
foreign  bodies  and  treatment  of  minor  eye  injuries. 

SUPPLIED:  4 cc.  plastic  squeeze,  dropper  bottle  containing 
Achromycin  Tetracycline  HCI  (1%)  10.0  mg.,  per  cc.,  sus- 
pended in  sesame  oil  . . . retains  full  potency  for  2 years 
without  refrigeration. 

*Reg.  U.  S.  Pat.  Off. 


LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 


1 


in  G.l.  disorders 

‘Compazine’  controls  tension 
—often  brings  complete  relief 

In  such  conditions  as  gastritis,  pylor- 
ospasm,  peptic  ulcer  and  spastic 
colitis,  ‘Compazine’  not  only  re- 
lieves anxiety  and  tension,  but  also 
controls  the  nausea  and  vomiting 
which  often  complicate  these 
disorders. 

Physicians  who  have  used  ‘Com- 
pazine’ in  gastrointestinal  disorders 
— often  in  chronic,  unresponsive 
cases — have  had  gratifying  results 
(87%  favorable). 

Compazine 

the  tranquilizer  and  antiemetic 
remarkable  for  its  freedom  from 
drowsiness  and  depressing  effect 

Available:  Tablets,  Ampuls,  Span- 
sule®  sustained  release  capsules, 
Syrup  and  Suppositories. 


■OT.M.  Reg.  U.S.  Pat.  OflF.  for  prochlorperazine,  S.K.F. 


Smith  Kline  & French  Laboratories,  Philadelphia 


FEBRUARY  ^ 1958 


Enhances  the  “prime  of  life” 


MI-CEBRIN 

(Vitamin-Mineral  Supplements,  Lilly) 


comprehensive  dietary  support  for 
healthy  tissue  metabolism 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.  S.  A. 


806018 


ESTABLISHEI 


COr^iATS  MOST  CLINIGALLY  IMPOBTAHT  PATHOGENS 

In  a recent  report  of  five  years’  experience  involving  2,142  patients, 
the  authors  conclude  that  CHLOROMYCETIN  (chloramphenicol, 
Parke-Davis)  is  a valuable  and  effective  antibiotic  in  the  treatment 
of  various  acute  infectious  diseases.^ 

Other  current  reports  of  in  vivo  and  in  vitro  studies  agree  that 
CHLOROMYCETIN  has  maintained  its  effectiveness  very  well 
against  both  gram-negative^'®  and  gram-positive^’®'^®  organisms. 

CHLOROMYCETIN  is  a potent  therapeutic  agent  and,  because  certain  blood 
dyscrasias  have  been  associated  with  its  administration,  it  should  not  be  used 
indiscriminately  or  for  minor  infections.  Furthermore,  as  with  certain  other  drugs, 
adequate  blood  studies  should  be  made  when  the  patient  requires  prolonged 
or  intermittent  therapy. 


REFERENOES  (1)  Woolington,  S.  S.;  Adler,  S.  J.,  & Bower,  A.  G.,  in  Welch,  H.,  & Marti- 
Ibanez,  E:  Antibiotics  Annual  1956-1957,  New  York,  Medical  Encyclopedia,  Inc.,  •'1957,  p.  365. 
(2)  Ditmore,  D.  C.,  & Lind,  H.  E.:  Am.  /.  Gastromterol.  28:378,  1957.  (3)  Hasenclever,  H.  E: 
/.  Iowa  M.  Soc.  47:136,  1957.  (4)  Waisbren,  B.  A.,  & StreUtzer,  C.  L.:  Arch.  Int.  Med.  99:744,  1957. 
(5)  Holloway,’W.  J.,  & Scott,  E.  G.:  Delaware  M.  J.  29:159,  1957.  (6)  Rhoads,  E S.:  Postgrad.  Med. 
21:563,  1957.  (7)  Petersdorf,  R.  G.;  Bennett,  I.  L.,  Jr.,  & Rose,  M.  C.:  Bull.  Johns  Hopkins  Hosp. 
100:1,  1957.  (8)  Royer,  A.:  Changes  in  Resistance  to  Various  Antibiotics  of  Staphylococci  and  Other 
Microbes,  paper  presented  at  Fifth  Ann.  Symp.  on  Antibiotics,  Washington,  D.  C.,  Oct.  2-4,  1957. 
(9)  Doniger,  D.  E.,  & Parenteau,  Sr.  C.  M.:  J.  Maine  M.  A.  48:120,  1957.  (10)  Josephson,  J.  E.,  & 
Butler,  R.  W.:  Canad.  M.  A.  J.  77:567  (Sept.  15)  1957. 


PARKE,  DAVIS  & COMPANY  • DETROIT  32,  MICHIGAN 


^ C A 


IE) 


t B 


IN  VITRO  SENSITIVITY  OF  MIXED  PATHOGENS  TO  CHLOROMYCETIN 

AND  4 OTHER  WIDELY  USED  ANTIBIOTICS*  i 

' fe 


{ 


ANTIBIOTIC  B 62% 


*Adapted  from  Ditmore  and  Lind.^  Organisms  tested  were  isolated  from  stools  of  48  patients. 


250Se 


THE  SOUTH  DAKOTA 

JOURNAL  OF  MEDICINE 

AND 

PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


Volume  XI  February  1958  Number  2 


CONTENTS 

MEDICAL  SECTION 

Roland  G.  Mayer,  M.D.  — 1891-1958  39 

What  is  the  Safest  Tonsillectomy  Anesthesia? 40 


John  B.  Gregg,  M.D.,  Sioux  Falls,  South  Dakota 

Reactions  to  Tetanus  Antitoxin:  Their  Etiology,  Prevention,  and  Treatment  46 
Frank  M.  James,  M.D.,  Broomfield  Heights,  Colorado  and 
Wallace  Marshall,  M.D.,  Two  Rivers,  Wisconsin 


The  Treatment  of  Emotional  Disturbances  In  Children 49 

Jerman  Rose,  M.D.,  Omaha,  Nebraska 

Obstetric  Case  Study 52 

R.  E.  Staats,  M.D.,  San  Antonio,  Texas 

President’s  Page 54 

M.  M.  Morrissey,  M.D.,  Pierre,  South  Dakota 

Editorial  Page 55 

Medical  Library  Bookshelf 58 

This  is  Your  Medical  Association 61 

PHARMACY  SECTION 

Animal  Health  Pharmacy 64 

Kenneth  Redman,  Ph.D.,  Brookings,  South  Dakota 

Preceptorship  — Your  Responsibility 67 

Albert  Edlin,  Richmond,  Virginia 

President’s  Page 71 

George  Lehr,  Rapid  City,  South  Dakota 

Recent  Pharmaceutical  Specialties 72 

Pharmacy  News  75 


Entered  as  second-class  matter  January  22,  1948  at  the  post  office  at  Sioux  Falls,  South  Dakota 

under  the  act  of  August  24,  1912 

Published  monthly  by  the  South  Dakota  Medical  Association,  Publication  Office 
300  First  National  Bank  Building,  Sioux  Falls,  South  Dakota 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


3 


”Since  we  put  him  on  NEOHYDRIN  he's  been 
able  to  stay  on  the  job  without  interruption/ 


4 

i 


oral 

organomercurial 

diuretic 


NEOHYDRIN 

BRAND  OF  CHLORMERODRIN 


LAKESIDE 


246S7 


4 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


FROM  THE  GRAY  FLANNELS 


EDUCATIONAL  COUNCIL 
FOR 

FOREIGN  MEDICAL  GRADUATES 
What  Functions  Will  It  Serve? 

It  will  distribute  to  foreign  medical  grad- 
uates around  the  world  authentic  information 
regarding  the  opportunities,  difficulties  and 
pit-falls  involved  in  coming  to  the  U.  S.  on  an 
exchange  visitor  or  exchange  student  visa  in 
order  to  take  training  as  an  intern  or  resident 
in  a U.  S.  hospital,  or  coming  on  an  immigrant 
visa  with  the  hope  of  becoming  licensed  to 
practice. 

It  will  make  available  to  properly  qualified 
foreign  medical  graduates  while  still  in  their 
own  country  a means  of  obtaining  ECFMG 
certification  (a)  to  the  effect  that  their  educa- 
tional credentials  have  been  checked  and 
found  meeting  minimal  standards  (18  years 
of  formal  education,  including  at  least  4 years 
in  a bona  fide  medical  school),  (b)  that  the 
command  of  English  has  been  tested  and 
found  adequate  for  assuming  an  internship 


in  an  American  hospital,  (c)  that  the  general 
knowledge  of  medicine  as  evidenced  by  pass- 
ing of  the  American  Medical  Qualification 
Examination  is  adequate  for  assuming  an  in- 
ternship in  an  American  hospital. 

It  will  provide  hospitals,  state  licensing 
boards,  and  specialty  boards  which  the 
foreign  medical  graduate  designates,  the  re- 
sults of  the  three-way  screening  available. 

Whai  Functions  Will  It  Not  Serve? 

It  will  not  serve  as  a placement  agency 
either  for  interns  or  residents.  Placement  ar- 
rangements must  be  made  by  the  foreign 
medical  graduate  directly  with  the  hospital 
of  his  choice. 

It  will  not  attempt  to  evaluate  the  teaching 
program  or  inspect  or  improve  any  foreign 
medical  school.  Its  program  is  based  not  upon 
evaluating  the  school  from  which  the  can- 
didate graduated  but  upon  evaluating  the 
professional  competence  of  the  individual. 

It  will  not  act  as  an  intercessor  for  foreign 
medical  graduates  having  problems  under 


WHEN  \ 
LIFE 
SEEMS 
OUT 
OF 

FOCUS 

‘ip 


BECAUSE  OF  TENSION.  MILD  BEFRESSION,^ 

anxiety,  fears-this  is  an  indication  I 


SUAYITI 


(bENACTYZINE  HYDROCHLORIlj 

a psychotropic  agent  with  specific  odvant 


5 


discussion  by  state  boards  of  medical  licen- 
sure or  specialty  boards.  If  the  foreign  med- 
ical graduate  asks  that  the  results  of  his  three- 
way  screening  be  sent  to  a designated  board 
this  will  be  done,  but  the  ECFMG  has  no 
right  and  no  desire  to  review  the  decisions 
of  the  properly  constituted  state  licensing 
boards  and  American  speciality  boards. 

What  is  the  Charge  to  Be? 

Foreign  medical  graduates  already  in  this 
country  will  be  billed  for  $50.00  covering  the 
cost  of  the  three-way  screening.  This  will  in- 
clude $15.00  for  the  evaluation  of  credentials 
and  $35.00  for  the  American  Medical  Quali- 
fication Examination. 

Foreign  medical  graduates  abroad  will  be 
billed  the  $50.00  only  if  and  when  they  pass 
the  screening,  receive  a position  in  an  Amer- 
ican hospital  or  are  otherwise  earning  Amer- 
ican dollars. 


American  hospitals  receiving  screened  can- 
didates will  be  billed  $75.00  for  each  such 
candidate  accepted. 

What  Are  the  Target  Dates  for  Various 
Services? 

The  answering  of  correspondence  began 
October  5th  and  has  been  kept  current  since 
that  time.  The  translation,  interpretations 
and  evaluation  of  credentials  has  already  be- 
gun. 

The  target  date  for  the  first  American  Med- 
ical Qualification  Examination  for  foreign 
medical  greduates  already  in  this  country  is 
set  for  February  or  March,  1958. 

The  target  date  for  the  second  American 
Medical  Qualification  Examination  for  for- 
eign medical  graduates  both  here  and  abroad 
is  set  for  August  or  September,  1958. 


RESTORE  PERSPECTIVE  WITH 
MILDLY  ANTIDEPRESSANT 

SUAVITIU 


ently,  gradually,  without  euphoric  buffering, 
lAVITIL  helps  patients  recover  normal  drive  and 
elps  free  them  from  compulsive  fixations. 


ECOMMENDED  DOSAGE:  1.0  rag.  t.i.d.  for  two  or  three 
lys.  If  necessary  this  dosage  may  be  gradually 
icreased  to  3 mg.  t.i.d. 


LS 


MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  & CO.,  Inc.,  PHILADELPHIA  1.  PA. 


THE  SOUTH  DAKOTA 


JOURNAL  OF  MEDICINE 

AND 


PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 

THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 

SUBSCRIPTION  $2.00  PER  YEAR  SINGLE  COPY  20c 


Volume  XI 


February  1958 


Number  2 


STAFF 


Acting  Editor 

Assistant  Editor 

Associate  Editor — 

Associate  Editor 

Associate  Editor — 

Associate  Editor 

Business  Manager. 


— Robert  E.  Van  Demark,  M.D Sioux  Falls,  S. 

Patricia  Lynch  Saunders Sioux  Falls,  S. 

Harold  S.  Bailey,  Ph.D,... Brookings,  S. 

D.  L.  Kegaries,  M.D. Rapid  City,  S. 

—J.  A.  Nelson,  M.D Sioux  Falls,  S. 

D.  H.  Manning,  M.D. Sioux  Falls,  S. 

John  C.  Foster Sioux  Falls,  S. 


D 

D 

D 

D 

D 

D 

D 


EDITORIAL  COMMITTEE 


D. 

D. 

D. 

H R WnlH,  M.D. 

D. 

D. 

D. 

D. 

T W RPiil,  M.n. 

D. 

R.  E.  Van  Demark,  M.D.  ..  „ .. 

Sioux  Falls,  S. 

D. 

PUBLICATIONS  COMMITTEE 

R.  G.  Mayer,  M.D.,  T.  H.  Saltier,  M.D.,  R.  E.  Van  Demark,  M.D.  and  the  Executive  Com- 
mittee of  The  South  Dakota  Pharmaceutical  Association. 


OFFICERS 


South  Dakota  Pharmaceutical  Association 


President 

First  Vice-President 

Second  Vice-President 
Third  Vice-President.. 
Fourth  Vice-President 

T reasurer 

Secretary 


■George  A.  Lehr  

.Vere  A.  Larsen  

.Willis  C.  Hodson  

Albert  H.  Zareeky  

.Phillip  E.  Case  

J.  C.  Shirley  

.Bliss  C.  Wilson  


South  Dakota  State  Medical  Association 

President M.  M.  Morrissey,  M.D. 

President  Elect 

Vice-President  

Secretary-Treasurer  

Executive  Secretary 

Delegate  to  A.M.A.  

Alternate  Delegate  to  A.M.A. — 

Chairman  Council Magni  Davidson,  M.D. 

Speaker  of  The  House C.  R.  Stoltz,  M.D 


A. 

A.  Lampert,  M.D. 

R. 

A.  Buchanan,  M.D. 

......A. 

P.  Reding,  M.D. . . 

.....A. 

A.  Lampert,  M.D. 

......A. 

P.  Reding,  M.D.  .. 

Sioux  Valley  Medical  Association 

President 

Vice-President 

Secretary  

Treasurer 


A.  P.  Reding,  M.D.  _ 
R.  P.  Carroll,  M.D.  .. 
Edward  Sibley,  M.D. 
A.  K.  Myrabo,  M.D.. 


Rapid  City,  S.  D 

Alcester,  S.  D 

Aberdeen,  S.  D 

Pierre,  S.  D 

Parker,  S.  D 

Brookings,  S.  D 

Pierre,  S.  D 


Pierre,  S.  D. 

. Rapid  City,  S.  D. 

Huron,  S.  D. 

Marion,  S.  D. 

Sioux  Falls,  S.  D. 
..Rapid  City,  S.  D. 

Marion,  S.  D. 

..  Brookings,  S.  D. 
Watertown,  S.  D. 


Marion,  S.  D. 

Laurel,  Nebr. 

_ Sioux  City,  Iowa 
Sioux  Falls,  S.  D. 


Some  doctors  have  questioned  the  use  of  tranquilizers  in  children.  They  feel,  and 
rightly  so,  that  these  drugs  should  not  be  used  as  palliatives  to  mask  distressing 
symptoms,  while  etiological  factors  go  uncorrected.  But  there  are  three  situations  in 
which  even  the  most  conservative  physician  would  not  hesitate  to  use  tranquilizers: 

1.  When  the  usually  well-adjusted  child  needs  a buffer  against  temporary  emo- 
tional stress,  such  as  hospitalization. 

2.  When  a child  needs  relief  from  an  anxiety-reaction  that  is  in  turn  anxiety- 
provoking,  so  as  to  pave  the  way  for  basic  therapy. 

3.  When  anxiety  underlies  or  complicates  somatic  disease,  as  in  asthma. 

In  such  situations,  tranquilizers  are  likely  to  be  more  effective  and  better  tolerated 
than  previously  accepted  therapy,  such  as  barbiturates. 

But  the  question  arises:  which  tranquilizer  is  suitable  for  children? 

Most  of  the  physicians  now  using  tranquilizers  in  pediatric  practice  have  found  the 
answer  to  be  ATARAX,  confirming  the  conclusions  of  repeated  clinical  studies. 


A., 


AJAMX 


^ in  any  ■ 
-ihypereinotive 


state 


■ lisr  ehiWhwd  fcehavior  disoraers 

10  mg.  taWeits-3*6  ymm,  one  tab- 
let Li.d.}  over  6 yearSs  two  tablets 
il.'A  Syrupy  3-6-  years,  one  tsp, 
t l.d.j  mer  # years,  two  tep.  tl.d. 


- for  iiitult  ttinsiojs  atsdl  anxiety 

25  mg.  tab?ets-'one  tablet  qJ.d, 

lor  s«vsr#  emoilonal  ilfeturfeanoes 
' . * 100  rag.  tablets— one  tablet  t.I.d. 

;Vfer  psfoilatric  aM  emottenal 
"%wiergeBel«s  - • , - , 

' Parpnteraf  SolutSbn— 25-50  mg. 
(1-2  ee.)  fntramuscalarfy,  3-4 
tlm»  dally,  at  4-hoi«  Intervals. 
Dosage  tor  ehlWren  under  3,2  not 
established. 


Supplied;  Tablets, -bottles  of  1.00,  Syrup, 
pint  bottte.  Parenteral  Solution,  10  ee. 
’ — 


ATARAX  is  effective  in  a wide  range  of  pediatric  indications. 

ATARAX  has  produced  a “striking  response”  in  a wide  range  of  hyperemotive  states.* 
In  a study  of  126  children,  “the  calming  effect  of  hydroxyzine  (ATARAX)  was 
remarkable”  in  90%.*  Among  the  conditions  that  are  improved  with  ATARAX  are 
tics,  nervous  vomiting,  stuttering,  temper  tantrums,  disciplinary  problems,  crying 
spasms,  nightmares,  incontinence,  hyperkinesia,  etc.* 


ATARAX  is  well  tolerated  even  by  children. 

“ATARAX  appears  to  be  the  safest  of  the  mild  tranquilizers.  Troublesome  side 
effects  have  not  been  reported. . . .”* 


ATARAX  offers  two  pediatric  dosage  forms. 

ATARAX  Syrup  is  especially  designed  for  acceptability  by  medicine-shy  youngsters. 
A small  10  mg.  tablet  is  also  available.  In  either  case,  you  will  get  a rapid,  uncom- 
plicated response.  Why  not,  for  the  next  four  weeks,  prescribe  ATARAX  for  your 
hyperemotive  pediatric  patients.  See  whether  you,  too,  don’t  find  it  eminently 
suitable. 


* Documentation  on  request 


pe;ice  OF  MIND 


(brand  of  myoroxyzihe) 


Medical  Director 


New  York  17,  New  York 
Division,  Chas.  Pfizer  & Co.,  Inc. 


In  a recent  controlled  study,*  Phenaphen 
was  found  more  effective  than  a standard  aspirin- 
phenacetin-cafleine  formula  for  relief  of 
moderate  to  severe  pain  . . . with  total  freedom  “ 
from  side  effects  and  from  any  tendency 
to  induce  drowsiness.  l 


•Murray,  R.  J.:  K.  Y.  State  Jl.  Med.  53:1867,  1953. 


Each  PHENAPHEN  capsule  contains  — 

Acetylsalicylic  Acid  (2^^  gr.)  . 162  mg. 

Phenacetin  (3  gr.) . 194  mg. 

Phenobarbital  (1/4  gr-) 16.2  mg. 

Hyoscyamine  Sulfate 0.031  mg. 

Also  available  — 

PHENAPHEN  with  CODEINE  PHOSPHATE  14  GR. 

Phenaphen  No.  2 

PHENAPHEN  with  CODEINE  PHOSPHATE  Vi  GR. 

Phenaphen  No.  3 

PHENAPHEN  with  CODEINE  PHOSPHATE  1 OR- 

Phenaphen  No.  4 


A.  H.  ROBINS  CO.,  Inc.,  RICHMOND  20,  VA. 

Ethical  Pharmaceuticals  of  Merit  since  1878 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


9 


REMARKABLE  EFFECTIVENESS  PLUS  A SAFETY  RECORD 
UNMATCHED  IN  SYSTEMIC  ANTIBIOTIC  THERAPY  TODAY 


Actually,  after  almost  six  years  of  extensive  use,  there  has  not  been  a single  report 
of  a serious  reaction  to  erythrocin.  And,  after  all  this  time,  the  incidence  of 
resistance  to  erythrocin  has  remained  exceptionally  low. 

You’ll  find  ERYTHROCIN  is  highly  effective  against  the  majority  of  coccal  infec- 
tions and  may  also  be  used  to  counteract  complications  from  Q Q ■ , 
severe  viral  attacks.  It  comes  in  Filmtabs  and  in  Oral  Suspension.  VAaAKMX 


Compocillin-V 


for  those 

penicillin-sensitive 

organisms 


Indications 

Against  all  penicillin-sensitive 
organisms.  For  prophylaxis  and 
treatment  of  complications  in 
viral  conditions.  And  as  a prophy- 
laxis in  rheumatic  fever  and  in 
rheumatic  heart  disease. 

Dosage 

Depending  on  the  severity  of  the 
infection,  125  to  250  mg.  (200,000 
to  400,000  units)  every  four  to  six 
hours.  For  children,  dosage  is  de- 
termined by  age  and  weight. 

Supplied 

Filmtabs  compocillin-v  (Potas- 
sium Penicillin  V,  Abbott)  come  in 
125  mg.  (200,000  units),  bottles  of 
50;  and  in  250  mg.  (400,000  units), 
bottles  of  25.  Oral  Suspension 
COMPOCiLLiN-v  (Hydrabamine 
Penicillin  V,  Abbott),  contains  180 
mg.  per  5-cc.  teaspoonful,  in  40-cc. 
and  80-cc.  bottles. 


e0207l 


THE  HIGHER  BLOOD  LEVELS  OF  COMPOCILLIN-V 

-IN  EASY-TO-SWALLOW  FILMTABS  AND  TASTY,  ORAL  SUSPENSION 


units/cc. 


16 


14 


12 


10 


8 


6 


4 


2 


0 


Fiimtab  Compocillin-V 
(Potassium  Feriicillin  V;  Abbott) 


Uncoatod  Potassium  PenlcilHn  V 


Buffered  Potassium  Peniciilin  G 


Doses  of  400,000  units  were  administered  before 
mealtime  to  40  subjects  involved  in  this  study. 


The  chart  repsesg^nts  a comparison  of  the  blood  levels  of 
FILMTAB  COMPOCI,iLIN-v  (Potassium  Pejiicillin  V,  Abbott) 
with  uncoated  gg^a^ium  penicillin  V,  and  with  buffered 
potassium  penicilllin  G.  Bar  heights  show  ranges,  while 
crossbars  show  ®iMians.  Note  the  high  I'anges  and  aver- 
Sfgm  of  FILMTAB  plMPOCiLLiN-y  at  % hcjur,  and  at  L hour,. 


Hours  V2 


1 


2 


4 


Now,  with  Fiimtab  COMPOCILLIN-V,  patients  get  (and  within  minutes)  fast,  high  peni- 
cillin concentrations.  Note  the  blood  level  chart. 

COMPOCILLIN-V  is  indicated  whenever  penicillin  therapy  is  desired.  It  comes  in 
two  highly-acceptable  forms.  Fiimtab  compocillin-v  offers  two  therapeutic  dosages 
(125  and  250  mg.).  Patients  find  Filmtabs  tasteless,  odorless  and  easy-to-swallow. 
For  children,  compocillin-v  comes  in  a tasty,  banana-flavored  0 0 ++ 

suspension.  It’s  ready-mixed  — stays  stable  for  at  least  18  months. 


Indications 


and  when 
coccal  infections 
hospitalize 
the  patient 


SPONTIN  is  indicated  for  treating  gram- 
positive bacterial  infections.  Clinical 
reports  have  indicated  its  effectiveness 
against  a wide  range  of  staphylococcal, 
streptococcal  and  pneumococcal  infec- 
tions. It  can  be  considered  a drug  of 
choice  for  the  immediate  treatment  of 
serious  infections  caused  by  organisms 
resistant  to  other  antibiotics. 

Dosage 

Recommended  dosage  depends  on  the 
sensitivity  of  the  microorganism  and  on 
the  severity  of  the  disease  under  treat- 
ment. For  pneumococcal  and  streptococ- 
cal infections,  a dosage  of  25  mg./Kg. 
per  day  will  usually  be  adequate.  Major- 
ity of  staphylococcal  infections  will  be 
controlled  by  25  to  50  mg./Kg.  per  day. 
However,  in  endocarditis  due  to  rela- 
tively resistant  strains  or  where  vege- 
tations or  abscesses  occur,  dosages  as 
high  as  75  mg./Kg.  per  day  may  be  used. 
It  is  recommended  that  the  daily  dosages 
be  divided  into  two  or  three  equal  parts 
at  eight-  or  twelve-hour  intervals. 

Supplied 

SPONTIN  is  supplied  as  a sterile,  lyophi- 
lized  powder,  in  vials  representing  500 
mg.  of  ristocetin  activity. 


602070 


A LIFESAVING  ANTIBIOTIC  AFTER  OTHER  ANTIBIOTICS  HAD  FAILED 


SPONTIN  comes  to  the  medical  profession  with  a clinical  history  of  dramatic  results 
— cases  where  the  patients  were  given  little  chance  of  survival. 

During  these  careful,  clinical  investigations,  lives  were  saved  after  weeks  (and 
sometimes  months)  of  antibiotic  failures.  These  were  the  cases  where  the  infecting 
organisms  had  become  resistant  to  present-day  therapy.  And,  just  as  important, 
were  the  good  results  found  against  a wide  range  of  gram-positive  Coccal  infections. 

Essentially,  spontin  is  a drug  for  hospital  use,  for  patients  with  potentially 
dangerous  infections.  In  its  present  form,  spontin  is  administered  intravenously 
using  the  drip  technique.  Dosage  may  be  dissolved  in  5%  dextrose  in  water  or  in 
any  isotonic  or  hypotonic  saline  solution.  Some  of  the  important  therapeutic  points 
of  SPONTIN  include : 

1 successful  short-term  therapy  for  acute  or  subacute  endocarditis 

2 new  antimicrobial  activity  --  no  natural  resistance  to  spontin  was  found  in 
tests  involving  hundreds  of  coccal  strains 

3 antimicrobial  action  against  which  resistance  is  rare  — and  extremely  diffi- 
cult to  induce 

4 bactericidal  action  at  effective  therapeutic  dosages. 

SPONTIN  is  truly  a lifesaving  antibiotic.  It  could  save  the  life  f \ 0 0 4-1- 
of  one  of  your  patients  — does  your  hospital  have  it  stocked?  \-AA)u~OTX 


DIRECTORY 


THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION 
Organized  1882  300  First  Nat’l  Bank  Bldg. 

Sioux  Falls,  South  Dakota 
OFFICERS,  1957-1958 
President 

M.  M.  Morrissey,  M.D — Pierre 


Secretary-Treasurer 


President-Elect 

A.  A.  Lampert,  M.D. 

A.  P.  Reding,  M.D. 

Vice  President 

R.  A.  Buchanan,  M.D. 

AMA  Delegate 

A.  A.  Lampert,  M.D - 

Alternate  Delegate  to  AMA 

A.  P.  Reding,  M.D 

Chairman  of  the  Council 
Magni  Davidson,  M.D. 


..Rapid  City 

Marion 

Huron 

Rapid  City 

Marion 


C.  R.  Stoltz,  M.D. 
A.  P.  Peeke,  M.D. 


Speaker  of  the  House 


Councilor-at-Large 


COUNCILORS 
First  District  (Aberdeen) 
P.  V.  McCarthy,  M.D.  (1959) 


....Brookings 
..Watertown 
...Volga 

Aberdeen 


Second  District  (Watertown) 

J.  J.  Stransky,  M.D.  (1959)  Watertown 

Third  District  (Brookings-Madison) 

Magni  Davidson,  M.D.  (1960)  . Brookings 


Fourth  District  (Pierre) 

L.  C.  Askwig,  M.D.  (1959)  

Fifth  District  (Huron) 
Paul  Hohm,  M.D.  (1960) 


-.Pierre 


..Huron 


Sixth  District  (Mitchell) 

P.  P.  Brogdon,  M.D.  (1960)  Mitchell 

Seventh  District  (Sioux  Falls) 

C.  J.  McDonald,  M.D.  (1960)  Sioux  Falls 

Eighth  District  (Yankton) 

T.  H.  Sattler,  M.D.  (1959)  . ..  ...Yankton 


Ninth  District  (Black  Hills) 

J.  D.  Bailey,  M.D.  (1958)  

Tenth  District  (Rosebud) 

R.  H.  Hayes,  M.D.  (1958)  . 

Eleventh  District  (Northwest) 

G.  C.  Torkildson,  M.D.  (1958)  

Twelfth  District  (Whetstone) 

E.  A.  Johnson,  M.D.  (1958) 


-Rapid  City 
Winner 


STANDING  COMMITTEES  — 1957-1958 
Scientific  Work 

M.  M.  Morrissey,  M.D.,  Chr.  

A.  A.  Lampert,  M.D Rapid  City 

R.  A.  Buchanan,  M.D Huron 

A.  P.  Reding,  M.D.  Marion 


-McLaughlin 
Milbank 

Pierre 


Legislation 

H.  Russell  Brown,  M.D.,  Chr . 

R.  E.  Van  Demark,  M.D. 

E.  T.  Ruud,  M.D.  

Paul  Bunker,  M.D 

C.  L.  Swanson,  M.D 

H.  R.  Lewis,  M.D.  . 


- Watertown 
-Sioux  Falls 
...Rapid  City 

Aberdeen 

Pierre 

Mitchell 


Publications 

R.  G.  Mayer,  M.D.,  Chr.  (1960)  

R.  E.  Van  Demark,  M.D.  (1958)  

T.  H.  Sattler,  M.D.  (1959) 


Medical  Defense 

A.  P.  Reding,  M.D.,  Chr.  (1958)  

Russell  Orr,  M.D.  (1959)  

D.  R.  Mabee,  M.D.  (1960)  


— Aberdeen 
..Sioux  Falls 
-Yankton 


Marion 

-Sioux  Falls 
Mitchell 


Medical  School  Affairs 
Medical  Education  and  Hospitals 

C.  B.  McVay,  M.D.,  Chr.  (1960)  

R.  C.  Jahraus,  M.D.  (1960)  

Ronald  Price,  M.D.  (1958)  ...  

F.  D.  Gillis,  Jr.,  M.D.  (1958)  

W.  H.  Saxton,  M.D.  (1959)  

F.  R.  Williams,  M.D.  (1959)  

Medical  Economics 

M.  Davidson,  M.D.,  Chr.  (1958)  

Abner  Willen,  M.D.  (1959)  


R.  H.  Hayes,  M.D. 

D.  J.  Glood,  M.D., 
J.  C.  Murphy,  M.D, 
J.  T.  Cowan,  M.D. 


(1960) 

Necrology 

Chr.  (1958)  

(1960)  

(1959)  

Public  Health 

Chr.  (1959)  

(1958) 


—Yankton 

Pierre 

—Armour 
..Mitchell 

Huron 

.Rapid  City 

— Brookings 

Clark 

Winner 


R.  K.  Rank,  M.D., 

F.  C.  Totten,  M.D. 

N.  E.  Wessman,  M.D.  (1960) 

Cancer 

P.  V.  McCarthy,  M.D.,  Chr.  (1960) 

W.  A.  Geib,  M.D.  (1958)  

J.  V.  McGreevy,  M.D.  (1959)  

Tuberculosis 

W.  L.  Meyer,  M.D.,  Chr.  (1960)  

R.  G.  Mayer,  M.D.  (1958)  

Saul  Friefeld,  M.D.  (1959) 

Maternal  & Child  Welfare 
Brooks  Ranney,  M.D.,  Chr.  (1959)  

L.  W.  Tobin,  M.D.  (1958)  

W.  A.  Anderson,  M.D.  (1960)  

Diabetes 

E.  W.  Sanderson,  M.D.  (1958)  

M.  E.  Sanders,  M.D.  (1959)  

Clifford  Gryte,  M.D.  (1960)  


.Viborg 

Murdo 

— Pierre 

Aberdeen 

Lemmon 

Sioux  Falls 

— Aberdeen 
-Rapid  City 
-Sioux  Falls 

- Sanator 

— - Aberdeen 
-Brookings 

Yankton 

Mitchell 

-Sioux  Falls 

. Sioux  Falls 

Redfield 

Huron 


Executive  Committee 

M.  M.  Morrissey,  M.D.,  Chr — .....Pierre 

A.  A.  Lampert,  M.D Rapid  City 

R.  A.  Buchanan,  M.D.  — . Huron 

C.  R.  Stoltz,  M.D Watertown 

A.  P.  Reding,  M.D Marion 

Magni  Davidson,  M.D Brookings 

Grievance  Committee 

L.  J.  Pankow,  M.D.,  Chr.  (1962)  Sioux  Falls 

R.  E.  Jernstrom,  M.D.  (1958)  Rapid  City 

D.  A.  Gregory,  M.D.  (1959)  Milbank 

A.  W.  Spiry,  M.D.  (1960)  Mobridge 

D.  S.  Baughman,  M.D.  (1961)  ..Madison 

Mental  Health 

George  Smith,  M.D.,  Chr.  (1960)  Sioux  Falls 

E.  S.  Watson,  M.D.  (1958)  Brookings 

Clark  Johnson,  M.D.  (1958)  Yankton 

R.  C.  Knowles,  M.D.  (1959)  Sioux  Falls 

H.  E.  Davidson,  M.D.  (1959)  Lead 

C.  E.  Baker,  M.D.  (1960)  Yankton 

Benevolent  Fund 

W.  E.  Donahoe,  M.D.,  Chr.  (1960)  Sioux  Falls 

J.  C.  Hagin,  M.D.  (1958)  — Miller 


"it  ,,  Rheumatic  Fever  and  Heart  Disease 
J.  Arga’vJ-ite,  M.D.,  Chr.  (1958)  Watertown 

B.  T.  L^z,  M.D.  (1959)  — Huron 

H.  W.  Farrell,  M.D.  (1960)  Sioux  Falls 

SPECIAL  COMMITTEES 
Radio  Broadcasts  and  Telecasts  Committee 

J.  J.  Stransky,  M.D.,  Chr Watertown 

J.  P.  Steele,  M.D Yankton 

J.  C.  Rodine,  M.D Aberdeen 

Robert  Olson,  M.D Sioux  Falls 

Wm.  Fritz,  M.D.  - Mitchell 

F.  D.  Leigh,  M.D .' Huron 

S.  B.  Simon,  M.D Pierre 

H.  L.  Ahrlin,  M.D.  Rapid  City 

American  Medical 
Education  Foundation 

A.  P.  Reding,  M.D.,  Chr Marion 

A.  A.  Lampert,  M.D.  Rapid  City 

O.  J.  Mabee,  M.D Mitchell 

H.  L.  Saylor,  Jr.,  M.D.  Huron 

S.  F.  Sherrill,  M.D — - Belle  Fourche 

Editorial 

R.  G.  Mayer,  M.D Aberdeen 

G.  S.  Paulson,  M.D.  Rapid  City 

Harold  Lowe,  M.D Mobridge 

H.  R.  Wold,  M.D Madison 

R.  E.  Van  Demark,  M.D.  ...Sioux  Falls 

T.  W.  Reul,  M.D Watertown 

Mary  Price,  M.D ...Armour 

Amos  Michael,  M.D.  .Vermillion 

M.  L.  Spain,  M.D — Rapid  City 

Medical  Licensure 

F.  F.  Pfister,  M.D Webster 

Magni  Davidson,  M.D.  Brookings 

C.  E.  Kemper,  M.D.  Viborg 

Veterans  Administration  and  Military  Affairs 

L.  C.  Askwig,  M.D.,  Chr.  Pierre 

M.  R.  Gelber,  M.D.  Aberdeen 

G.  H.  Steele,  M.D.  Aberdeen 

T.  J.  Billion,  M.D Sioux  Falls 

Spafford  Memorial  Fund 

T.  E.  Eyres,  M.D.  Vermillion 

Prepayment  and  Insurance  Plans 

C.  J.  McDonald,  M.D.,  Chr.  Sioux  Falls 

D.  H.  Breit,  M.D Sioux  Falls 

Paul  Hohm,  M.D.  Huron 

E.  A.  Johnson,  M.D Milbank 

A.  A.  Lampert,  M.D.  Rapid  City 

Robert  Monk,  M.D.  Yankton 

T.  H.  Sattler,  M.D.  .Yankton 

Rural  Medical  Service 

A.  P.  Peeke,  M.D.,  Chr Volga 

G.  J.  Bloemendaal,  M.D Ipswich 

E.  F.  Kalda,  M.D.  Platte 

Nursing  Training 

J.  A.  Muggly,  M.D.,  Chr.  Madison 

C.  L.  Vogele,  M.D.  —Aberdeen 

G.  F.  Gryte,  M.D — Huron 

Workmen’s  Compensation 

J.  N.  Hamm,  M.D.,  Chr Sturgis 

H.  R.  Lewis,  M.D.  Mitchell 

R.  Giebink,  M.D Sioux  Falls 

Blood  Banks 

W.  A.  Geib,  M.D.,  Chr Rapid  City 

R.  L.  Carefoot,  M.D.  Huron 

A.  K.  Myrabo,  M.D.  Sioux  Falls 

Rehabilitation  Committee 

R.  E.  Van  Demark,  M.D.,  Chr.  Sioux  Falls 

Paul  Bunker,  M.D.  Aberdeen 

W.  A.  Dawley,  M.D Rapid  City 

H.  L.  Ahrlin,  M.D.  Rapid  City 

Mary  Schmidt,  M.D.  Watertown 

Press  Radio  Committee 

R.  E.  Jernstrom,  M.D.,  Chr.  Rapid  City 

E.  A.  Rudolph,  M.D Aberdeen 

Steve  Brzica,  M.D.  Sioux  Palls 

Care  of  the  Indigent 

H.  P.  Adams,  M.D.,  Chr.  Huron 

A.  P.  Peeke,  M.D Volga 

H.  Russell  Brown,  M.D Watertown 

P.  P.  Pfister,  M.D.  Webster 

P.  V.  McCarthy,  M.D.  Aberdeen 

E.  J.  Perry,  M.D Redfield 

R.  F.  Hubner,  M.D Yankton 

C.  A.  Johnson,  M.D.  ..Lemmon 


need  not  rely  on  "wishing” 


To  assure 
good 

nutrition- 


Each  double-layered  Entozyme 

tablet  contaitis: 

Pepsin,  N.E 250  mg. 

— released  in  the  stomach  from 
gastric-soluble  outer  coating 
of  tablet. 

Pancreatin,  U.S.R 300  mg. 

Bite  Salts  150  mg. 

— released  in  the  small  intestine 

from  enteric-coated  inner 
core. 

A.  H.  ROBINS  CO.,  INC. 

Richmond  20,  Virginia 

Ethical  Pharmaceuhcati  of  Merit  since  1878 


As  a comprehensive  supplement  to  deficient  natural 
secretion  of  digestive  enzymes,  particularly  in  older 
patients,  ENTOZYME  effectively  improves  nutrition  by 
bridging  the  gap  between  adequate  ingestion  and  proper 
digestion.  Among  patients  of  all  ages,  it  has  proved  help- 
ful in  chronic  cholecystitis,  post-cholecystectomy  syn- 
drome, subtotal  gastrectomy,  pancreatitis,  dyspepsia, 
food  intolerance,  flatulence,  nausea  and  chronic  nutri- 
tional disturbances. 


For  comprehensive  digestive  enzyme  replacement— 


ENTOZYME'B 


16 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


N0W...A  NEW  TREATMENT 


'Cardilate'  tablets  shaped  for  easy  retention 

in  the  buccal  pouch 

**. . . the  degree  of  increase  in  exercise  tolerance  which  sublingual  ery- 
throl  tetranitrate  permits,  approximates  that  of  nitroglycerin,  amyl 
nitrite  and  octyl  nitrite  more  closely  than  does  any  other  of  the  approxi- 
mately 100  preparations  tested  to  date  in  this  laboratory.” 

“Furthermore,  the  duration  of  this  beneficial  action  is  prolonged  suffi- 
ciently to  make  this  method  of  treatment  of  practical  clinical  value.” 

Riseman,  J.  E.  F.,  Altman,  G.  E.,  and  Koretsky,  S.: 
Nitroglycerin  and  Other  Nitrites  in  the  Treatment  of 
Angina  Pectoris,  Circulation  (Jan.)  1958. 


‘Cardilate’  brand  Erythrol  Tetranitrate  SUBLINGUAL  TABLETS,  15  mg.  scored 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  Tuckahoe,  New  York 


Lederle  announces  a major  drug  with  great  new  promise 


a new  corticosteroid  created  to  minimize  the 
major  deterrents  to  all  previous  steroid  therapy 


9 alpha-fluoro-16  alpha-hydroxyprednisolone 


Q a new  liigh  in  anti-inflammatory  effects  with  lower  dosage 

(averages  less  than  prednisone) 

Q a new  low  in  the  collateral  hormonal  effects  associated 

with  all  previous  corticosteroids 

Q No  sodium  or  water  retention 
Q No  potassium  loss 

Q No  interference  with  psychic  equilibrium 
Q Lower  incidence  of  peptic  ulcer  and  osteoporosis 


UEDIBLE  LABORATOBISS  DIVISION.  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVEB.  NEW  YORK 


20 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


FROM  THE  GRAY  FLANNELS 


SURVEY  SHOWS  DISTANCES  COVERED 
AND  TIME  SPENT  ON  HOUSE  CALLS 

What’s  the  farthest  distance  the  typical 
doctor  travels  on  an  ordinary  house  call?  And 
how  long  does  the  usual  house  call  take  him? 

In  the  third  of  a series  of  articles  based  on 
a recent  study  of  1,200  doctors’  house-call 
habits,  the  February  17  issue  of  Medical  Eco- 
nomics reports  that  the  typical  house-call 
radius  varies  as  follows  by  type  of  locality: 
Urban  areas.  8 miles 

Surban  areas:  8 miles 

Metropolitan  areas:  10  miles 

Rural  areas:  15  miles 

Suprisingly  enough,  the  article  continues, 
doctors  in  all  four  areas  report  that  the  house 
call  takes  them  about  forty-five  minutes,  in- 
cluding travel  time  both  ways.  Why  this 
unanimity?  Probably,  explains  Medical  Eco- 
nomics, because  although  the  rural  physician 
goes  farther,  “the  open  roads  and  open  park- 
ing spaces  of  rural  areas  permit  the  country 
medical  man  to  get  where  he’s  going  without 
the  long  delays  imposed  by  city  traffic.” 


NATIONAL  MEETING  ON  WORKER 
HEALTH 

How  to  keep  workers  healthy  and  on  the 
job  through  control  of  hazardous  exposures 
in  the  working  environment  and  provision  of 
preventive  medical  services  in  industry  will 
be  the  subject  of  a national  Industrial  Health 
Conference,  to  be  held  in  Atlantic  City,  New 
Jersey,  April  19-25,  1958.  The  Conference,  an 
annual  meeting,  brings  together  physicians, 
nurses,  engineers,  chemists,  toxicologists,  and 
other  specialists  to  discuss  recent  develop- 
ments, problems,  and  progress  in  worker 
health. 

Expected  to  attend  the  Conference  are 
over  3,000  members  of  the  five  participating 
organizations,  the  Industrial  Medical  Associa- 
tion, The  American  Association  of  Industrial 
Dentists,  the  American  Association  of  Indus- 
trial Nurses,  and  the  American  Conference  of 
Governmental  Industrial  Hygienists,  as  well 
as  representatives  of  industrial  management, 
labor,  and  others  concerned  with  health  in 
industry. 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


21 


NATIONAL  FOUNDATION  FOR 
INFANTILE  PARALYSIS  OFFERS 
FELLOWSHIPS  FOR  TISSUE  CULTURE 
COURSE 

The  National  Foundation  for  Infantile 
Paralysis  is  again  offering  fellowships  to  post- 
doctoral  investigators,  teachers,  graduate 
students  and  experienced  laboratory  person- 
nel with  the  baccalaureate  degree  for  par- 
ticipation in  short  courses  in  tissue  culture. 

Fellowship  may  be  used  for  study  only  in 
formal  courses  designed  to  teach  the  prin- 
ciples, techniques,  and  application  of  tissue 
culture.  Funds  will  be  awarded  for  the  period 
necessary  to  complete  the  course,  which,  in 
most  instances,  is  not  expected  to  exceed  six 
weeks. 

Further  information  and  application  forms 
may  be  obtained  from  the  Division  of  Pro- 
fessional Education.  Completed  application 
should  reach  the  National  Foundation  at 
least  six  weeks  prior  to  the  beginning  of  the 
course. 


STUDY  SHOWS  ABSENCE  OF  SERIOUS 
SIDE  EFFECTS  ENHANCES  TRILAFON 
FOR  OFFICE  USE 

Evidence  that  the  absence  of  serious  side 
effects  from  Trilafon  “enhances  its  value  for 
office  use”  in  the  treatment  of  any  psychiatric 
patient  manifesting  anxiety,  tension,  agitation 
and  psychomotor  excitement  was  reported 
in  the  October,  1957,  issue  of  Diseases  of  the 
Nervous  System. 

Dr.  Frank  J.  Ayd,  Jr.,  reported  that  in  a 
carefully  planned  test  the  tranquilizer  was 
administered  to  300  neurotic  and  psychotic 
patients  between  the  ages  of  16  and  80  who 
manifested  anxiety,  agitation,  or  psychomotor 
excitement  as  the  perdominant  symptom.  The 
majority,  he  reports,  were  treated  on  an  am- 
bulatory basis,  but  some  initially  were  treated 
in  a general  hospital  or  a psychiatric  institu- 
tion. 


(PARABROMDYLAMINE  MALEATE) 


TABLETS  (4  MG.),  ELIXIR  (2  MG..BER  5 
AND  EXTENTABS®(l2MG.i) 


UNEXCELLED, 


E^SEDMHERAPEUTIC 
LATIVE  SAFETY.  MINIMUM 
AND  OTHER  SIDE  EFFECTS. 
S CO.,  INC,  RICHMOND,  VIR- 


AL  PHARMACEU- 
RIT  SINCE  1878 


where  there’s  a cold 

there’s 

CORICIDIN 


when  it’s  a simple  cold 

A CORICIDIN®  TABLETS 


when  it’s  an  all-over  cold 


CORICIDIN  FORTE 

CAPSULES 

when  infection  threatens  the  cold 


CORICIDIN  with  PENICILLIN 

TABLETS 


when  pain  is  a dominating  factor 

A CORICIDIN  with  CODEINE 

Cgr.  V4  or  gr.  '/i)  TABLETS  0 

when  children  catch  cold 

CORICIDIN  MEDILETS® 


when  cough  marks  the  cold 

CORICIDIN  SYRUP® 

0 Narcotic  for  which  oral  R is  permitted 
® Exempt  narcotic 

SCHERING  CORPORATION  • BLOOMFIELD,  NEW  JERSEY 


1 


puts  colds  down 


gets  patients  up 


CORICIDIN  FORTE 


on  Rx  only 

for  “get-up-and-go• ** 

METHAMPHETAMINE 

• buoys  spirits  « potentiates  pain  relief  • aids 
decongestive  action 

for  stress  support  VITAMIN  C 

• supplements  illness  requirements  • bolsters 
resistance  to  infection 

for  extra  relief  ANTIHISTAMINE 

• higher  dosage  strength  • optimal  therapeutic 
benefit  • virtually  no  side  effects 


CAPSULES 

Each  red  and  yellow  Coricidin  Forte 
Capsule  provides : 

CHLOR-TRiMETON®Maleate  . . 4 mg. 

(chlorprophenpyridamine  maleate) 

Salicylamide 0.19  Gm. 

Phenacetin 0.13  Gm. 

Caffeine 30  mg. 

Ascorbic  acid 50  mg. 

Methamphetamine 

hydrochloride 1.25  mg. 

On  Rx  and  cannot  he  refilled  without 
your  permission 

dosage 

One  capsule  every  four  to  six  hours. 
packaging 

Bottles  of  100  and  1000. 

Coricidin,®  brand  of  analgesic-antipyretic. 


SCHERING  CORPORATION  • BLOOMFIELD,  NEW  JERSEY 


24 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


the  bactericidal  action  makes  the  difference 


In  addition  to  rapid  clinical  re- 
sponse, 'Ilotycin’  provides  the 
important  advantages  only  a bac- 
tericidal antibiotic  can  give  you. 
'Ilotycin’  effectively  eliminates 
strep,  carrier  states,  directly  kills 
pathogens  to  prevent  the  emer- 
gence of  resistant  strains,  and  of- 
fers maximum  assurance  against 
spread  of  infection. 


Also  consider  'Ilotycin’  for  safer 
therapy.  Allergic  reactions  follow- 
ing systemic  treatment  are  rare. 
Bacterial  flora  of  the  intestine  is 
not  significantly  disturbed. 

You  can  achieve  more  complete 
antibiotic  therapy  with  'Ilotycin.’ 

Usual  adult  dosage  is  250  mg. 
every  six  hours. 

*'llotycin’  {Erythromycin,  Lilly) 


. INDIANAPOLIS  6,  INDIANA,  U.S.A. 


ELI  LILLY  AND  COMPANY 


832007 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


25 


stimulates  protein  synthesis, 
corrects  negative  nitrogen  balance 


Nilevar 


Increased  nitrogen  loss,  with  resulting  nega- 
tive nitrogen  balance,  occurs  in  infection, 
trauma,  major  surgery,  extensive  burns,  cer- 
tain endocrine  disorders  and  starvation  and 
emaciation  syndromes.  The  intrinsic  control 
of  protein  metabolism  is  lost  and  a protein 
“catabolic  state”  occurs.  A patient  requiring 
more  than  ten  days  of  bedrest  usually  has  had 
sufficient  metabolic  insult  i to  precipitate  such 
a “catabolic”  phase. 

Nilevar  (brand  of  norethandrolone)  has 
been  used  in  patients  with  varied  conditions 
including  hyperthyroidism,  poliomyelitis, 
aplastic  anemia,  glomerulonephritis,  anorexia 
nervosa  and  postoperative  protein  depletion. 
The  patients  gained  weight  and  felt  better. 


It  was  concluded  2 that  “the  drug  certainly 
caused  a reversal  of  rather  recalcitrant  or 
progressive  catabolic  patterns  of  disease.” 

Nilevar  is  unique  among  anabolic  steroids 
in  that  androgenic  side  action  is  minimal  or 
absent. 

The  suggested  adult  dosage  is  three  to  five 
tablets  (30  to  50  mg.)  daily.  For  children  1.5 
mg.  per  kilogram  of  weight  is  recommended. 

G.  D.  Searle  & Co.,  Chicago  80,  Illinois. 
Research  in  the  Service  of  Medicine. 


1.  Axelrod,  A.  E.;  Beaton,  J.  R.;  Cannon,  P.  R.,  and  others: 
Symposium  on  Protein  Metabolism,  New  York,  The  National 
Vitamin  Foundation,  Incorporated,  (March)  1954,  p.  100. 

2.  Proceedings  of  a Conference  on  the  Clinical  Use  of  Ana- 
bolic Agents,  Chicago,  Illinois,  G.  D.  Searle  & Co.,  April  9, 
1956,  pp.  32-35. 


$ 


26 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


'OtClMLy 


A few  suggestions  on  how  to  give 
your  patient  a diet  he  can  “stick-to’’~ 


The  Low 
Sodium  Diet 


and  a glass  of 
beer,  with  your 
consent  for  a 
morale-booster 


Here  are  some  things  your  patient  can  do 
to  season  his  Low  Sodium  Diet.  Spices  and 
herbs,  lemon  and  lime,  variously  flavored  vine- 
gars and  some  pepper  are  all  he  needs. 

Thyme,  marjoram  and  pepper  add  zest  to 
hamburger.  Chicken’s  delicious  with  lemon, 
rosemary  and  sweet  butter  to  baste.  He  can 
try  sweet  butter  with  nutmeg  on  green  beans. 


savory  on  limas,  tarragon  with  carrots,  basil 
with  tomatoes.  Onions  boiled  with  whole  clove 
and  thyme  delight  the  taste  of  an  epicure ! 

With  these  flavor  tricks  to  add  zest  to  his 
meals — and  a glass  of  beer*  now  and  then,  at 
your  discretion,  your  patient  has  a diet  that’s 
both  good  tasting  and  good  for  him. 

*Sodium;  7 mg./lOO  gm.,  17  mg./8  oz.  glass  (Average  of  American  Beers) 


United  States  Brewers  Foundation 

Beei  — America’s  Beverage  of  Moderation 


If  you'd  like  reprints  of  1 2 different  diets,  please  write  United  States  Brewers  Foundation,  535  Fifth  Avenue,  New  York  17,  N.  Y, 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


27 


USE 

POLYSPORIN- 


brantfi 

POLYMYXIN  B-BACITRACIN  OINTMiNT 


to  hAmi-i9beS(^ 


For  topical  use:  in  V^  oz.  and  1 oz.  tubes. 
For  ophthalmic  use:  in  >/•  oz.  tubes. 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  TucKahoe.  N.  V, 


28 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


for  total  management 
of  your  hypertensive 
patients  rely  upon 


help  reduce 
the  pressures 
ON  your 
patients 


help  reduce 
the  pressures 
IN  your 
patients 


Squibb  Who!®  Root  Rauwolfia  Serpentina 


Raudixin  provides  gradual,  sustained  lowering  of 
blood  pressure  in  hypertensive  patients,  as  well  as 
a mild  bradycardia.  Hence,  the  work  load  of  the 
heart  is  reduced. 

. . often  preferred  to  reserpine  in  private 
practice  because  of  the  additional  activity 
of  the  whole  root.” 


Corrin,  K.  M.:  Am.  Praet.  & Dig.  Treatment  8:721  (May)  1957. 


Tranquilizing  Raudixin  helps  relax  the  anxious 
hypertensive  patient  so  that  he  is  better  able  to 
cope  with  external  pressures  without  being  over- 
whelmed by  them.  By  reducing  these  anxieties  and 
tensions,  Raudixin  helps  break  the  mental  tension 
—hypertension  cycle. 

Dosage:  Two  100  mg.  tablets  once  daily;  may  be  adjusted 
within  range  of  50  to  300  mg.  Supply:  50  and  100  mg.  tablets. 
Bottles  of  100, 1000  and  5000. 

\ 

\ 

'\ 

•RAOOJWM**  IS  A 


Squibb 


Squibb  Quality~the  Priceless  Ingredient 


SQUIBB  TAABEHARR 


FEBRUARY  1 958 


ROLAND  G.  MAYER.  M.D. 

1891—1958 

Two  days  after  he  wrote  his  last  editorial  for  the  South  Dakota  Journal  of  Medicine  (see 
January  issue)  Dr.  R.  G.  Mayer  died  from  a combination  of  factors  involving  Carcinoma  of  the 
lungs  and  an  old  Coronary  condition. 

Long  a leader  in  South  Dakota  medicine,  Dr.  Mayer  had  served  as  secretary  of  the  State 
Medical  Association  from  1943  to  1951.  He  was  elected  vice-president  in  1952  and  rose  to  the 
presidency  in  the  year  1954.  Doctor  was  instrumental  in  pulling  together  for  joint  medical 
meetings  the  associations  of  the  two  Dakotas  in  1921  and  again  in  1956.  As  secretary  of  the 
State  Association  he  led  a successful  plan  to  establish  as  executive  office  which  was  accom- 
plished in  1946. 

For  a number  of  years,  he  stood  practically  alone  in  his  desire  for  a South  Dakota  medical 
journal.  In  1948  he  piloted  the  first  issue  of  the  South  Dakota  Journal  of  Medicine  and  Phar- 
macy on  what  was  at  that  time,  a precarious  journey.  He  stayed  on  as  editor  by  unanimous 
approval  of  the  Association’s  Council  to  the  date  of  his  death.  As  editor,  he  served  on  the  five- 
man  board  of  directors  of  the  State  Medical  Journal  Advertising  Bureau  in  Chicago  and  on 
the  board  of  the  American  Medical  Writers  Association. 

Always  interested  in  preventive  medicine  he  served  as  Aberdeen  school  physician  and  city 
health  officer  as  well  as  chairman  of  the  Medical  Association’s  School  Health  Committee. 

An  ardent  sports  fan,  any  sporting  event  in  Aberdeen  was  barely  considered  official  un- 
less he  was  there.  His  golf  clubs  were  quieted  shortly  during  recovery  from  his  first  heart 
attack.  Death  stilled  them  for  the  last  time  but  he  played  right  up  into  the  late  Fall  months. 
Late  in  November  he  attended  the  Minnesota-Wisconsin  game  where  his  first  irritating  cough 
became  evident. 

One  of  his  loves  was  the  Elks  Club  and  the  Elks  Chorus.  At  the  last  State  Medical  meet- 
ing held  in  Aberdeen,  he  sang  with  them  as  they  entertained  the  doctors  and  their  wives.  On 
January  11th,  the  chorus  sang  at  his  funeral  service. 

A good  husband,  father,  and  grandfather,  he  leaves  his  widow,  two  sons,  one  of  them  a sur- 
geon in  Oregon,  and  a daughter  as  well  as  a number  of  grandchildren  who  knew  him  not  as 
“Grandpa”  but  as  “Doc.” 

The  factual  data,  born  at  Summerfield,  111.,  educated  at  Rush  Medical  College,  married  to 
Olive  M.  Gabler  does  not  adequately  describe  the  man. 

South  Dakota  medicine  has  lost  one  of  its  strongest  voices  but  the  memory  of  “Dutch” 
and  his  works  will  live  on. 


— 39  — 


WHAT  IS  THE  SAFEST  TONSILLECTOMY 
ANESTHESIA?* 

John  B.  Gregg,  M.D. 

Sioux  Falls,  S.  Dak. 


Tonsillectomy,  adenoidectomy,  or  the  com- 
bination is  probably  the  most  frequently  per- 
formed operation  in  this  country  today.  It  is 
usually  thought  of  as  a benign  procedure.  Yet 
in  the  past  there  have  been  reported  more 
serious  complications,  such  as  cardiac  arrest, 
lung  abscess,  pneumonia  and  hemorrhage 
during  adenotonsillectomy  than  with  any 
other  single  surgical  procedure.  Unfortun- 
ately, the  attitude  has  arisen  that  tonsillec- 
tomy and  adenoidectomy  are  “minor  sur- 
gery.” In  fact,  it  was  recently  stated  “in  jest” 
by  Dr.  John  De  Tar^^),  President  of  the 
American  Academy  of  General  Practice,  in  a 
debate  as  to  whether  surgery  should  be  done 
by  general  practitioners,  “All  I do  is  tonsils; 
but  that  isn’t  really  surgery.”  This  concept 
of  tonsil  and  adenoid  surgery,  believed  by 
many  lay  and  medical  persons,  is  potentially 
dangerous  and  should  not  be  tolerated. 

The  American  Association  of  Nurse  Anes- 
thetists^)  reports:  “18%  of  today’s  hospital 
anesthetics  are  being  given  by  anesthes- 
iologists. Another  34%  is  administered  by 
nurse  anesthetists.  The  rest  of  the  hospital 
administered  anesthesia  is  given  as  follows: 
27%  by  doctors  who  aren’t  anesthesiologists; 
19%  by  nurses  who  don’t  have  A.A.N.A. 
qualifications;  2%  by  persons  who  aren’t 
either  doctors  or  nurses.”  These  figures  do 
not  begin  to  reflect  the  anesthetics  which  are 
given  in  physicians’  offices  by  the  doctor  him- 

* Presented  at  the  McKennan  Hospital  Staff  Clinic 

on  Sept.  25,  1957. 


self  or  by  someone  else,  trained  or  untrained. 

The  greatest  single  problem  in  the  safe 
tonsil  operation  is  the  anesthetic,  and  most 
authorities  feel  that  90%  of  the  problems 
which  arise  are  related  directly  to  the  anes- 
thetic. Because  of  the  difficulty  with  the  air- 
way, different  methods  and  techniques  of 
anesthesia  4)  5)  6)  7)  8)  9)  10)  11)  12)  13)  14)  15) 
16)  17)  18)  have  been  advocated  to  improve  the 
safety  potential  during  the  operation. 

The  ideal  anesthetic  for  adenotonsillec- 
tomy, as  in  any  other  operation,  has  three 
major  objectives:  (1)  safety  to  the  patient, 
(2)  facilitation  of  the  surgery,  and  (3)  con- 
venience of  administration.  These  are  im- 
portant in  this  order.  However,  the  prin- 
cipal function  of  the  anesthetic  is  simply  to 
aid  and  facilitate  the  operative  procedure, 
whatever  it  may  be. 

In  the  past  few  years  several  investigators 
19)20)21)22)  have  been  quite  enthusiastic  in 
their  praise  of  endotracheal  anesthesia  for 
adenotonsillectomy.  The  majority  of  the 
favorable  reports  have  been  from  anesthe- 
tists. The  usual  reasons  advanced  for  the  use 
of  intubation  during  tonsillectomy  under  gen- 
eral anesthesia  are  as  follows:  (1)  To  improve 
and  control  the  airway.  (2)  It  prevents  foreign 
material  from  entering  the  trachea.  (3)  In- 
tubation makes  possible  the  use  of  shorter- 
acting  agents,  with  which  the  patients  are 
awake  sooner  after  surgery  and  have  less 
nausea  and  vomiting  postoperatively.  (4)  A 
tube  allows  better  oxygenation  and  greater 


— 40  — 


FEBRUARY  1958 


ease  in  administering  oxygen,  increasing  the 
safety  factor. 

Several  problems  are  usually  noted  when 
using  the  intubation  technique  of  anesthe- 
sia.23)  These  include  (1)  increased  time  con- 
sumed and  difficulty  with  anesthesia  induction 
due  to  the  intubation;  (2)  technical  difficulty 
working  with  the  tube  in  the  mouth  or  in  the 
nose,  especially  in  children;  (3)  increased 
throat  trauma  and  laryngeal  complications 
following  intubations;  (4)  difficulty  with  in- 
tubation of  very  young  patients,  and  (5)  in- 
creased tendency  for  bleeding  when  some 
anesthetic  agents  other  than  ether  (thiopental 
(Pentothal)  are  used. 

Of  the  various  anesthetic  agents  available, 
only  a few  are  suitable  for  tonsillectomy.  For 
adults  local  analgesia  is  preferable  to  general 
anesthesia.  In  adults  who  are  unsuitable  for 
local  analgesia,  general  anesthesia  adminis- 
tered with  an  endotracheal  tube  in  place  is 
definitely  preferable  because  maintenance  of 
the  airway  is  a tremendous  problem,  es- 
pecially if  there  is  any  degree  of  coughing  or 
bleeding.  There  is  less  bleeding  if  ether  is 
used  in  the  adult  patients,  because  of  the  ad- 
renergic effect  of  ether. 

Of  the  drugs  in  common  usage,  ether  still 
possesses  the  properties  desirable  in  an  an- 
esthetic for  adenotonsillectomy  in  children. 
It  is  safe,  dependable,  easily  controlled  (des- 
pite the  method  of  administration),  and  does 
not  product  any  significant  undesirable  side- 
effects.  It  is  an  agent  which  can  be  given  with 
a reasonable  degree  of  safety  by  persons  who 
may  have  had  less  than  the  desirable  amount 
of  training  in  anesthesia.  Induction  can  be 
accomplished  with  vinyl  ether,  nitrous  oxide, 
or  with  ether  itself. 

A recent  survey  of  tonsillectomy  anes- 
thesia in  155  teaching  hospitals  in  this  coun- 
try, conducted  by  D.  W.  Hamrick,24)  showed 


that  the  first  three  choices  of  anesthesia  and 
anesthetic  technique  for  children,  in  order 
of  preference,  were  (1)  vinyl  ether  induction 
with  ether  maintenance  by  insufflation,  (2) 
drop  ether  for  induction  with  ether  mainten- 
ance, and  (3)  nitrous  oxide-oxygen  induction 
with  ether  by  endoctracheal  administration. 
It  is  significant  that  even  under  optimum 
conditions  insufflation  anesthesia  with  ether 
is  preferred. 

Because  the  insufflation  technique  of  ton- 
sillectomy anesthesia  has  been  subject  to 
criticism,  a study  was  set  up  to  determine 
how  much  difficulty  is  actually  encountered 
during  and  after  tonsillectomy  using  this 
technique  of  anesthesia. 

A series  of  100  consecutive  tonsillectomy, 
adenoidectomy,  and  adenotonsillectomy  pa- 
tients, all  done  by  one  surgeon,  were  studied 
carefully.  During  the  same  time,  380  similar 
operations  were  done  in  the  two  Sioux  Falls 
hospitals  by  other  surgeons. 

The  patients  (Table  1)  in  this  series  were 
operated  upon  as  two  large  groups,  the  op- 
erative position  being  the  differentiating 
feature.  The  first  50  patients  were  placed  on 
their  right  side,  with  the  operator  sitting  be- 
side the  operating  table.  The  last  50  patients 
were  placed  upon  their  backs,  with  the  head 
hyerextended,  the  operating  table  being  low- 
ered 10-15  degrees  for  the  head-low  position. 
In  the  latter  position,  the  operator  sat  at  the 
head  of  the  table.  The  operations  were  done 
at  two  hospitals,  71  at  one  and  29  at  the 
other,  but  operating  conditions  were  the  same 
at  both  hospitals.  Insofar  as  possible,  opera- 
tion conditions  were  standardized.  The  in- 
duction time  (Table  2),  operation  time  (Table 
3),  wake-up  time  (computed  to  the  time  the 
patient  responded  to  vocal  stimulus,  i.e.,  open- 
ing the  eyes,  etc.)  (Table  4),  and  total  anes- 
thetic time  (Table  5)  were  recorded. 


TABLE  NO.  1 


AGE  DISTRIBUTION  IN  ONE  HUNDRED  ADENTONSILLECTOMY 
AND  ADENOIDECTOMY  PATIENTS 


12-18  mo. 

18-24  mo. 

2-3  yr. 

3-4  yr. 

4-6  yr. 

6-10  yr. 

10-15  yr. 

15-25  yr. 

25  yr. 

Plus 

T and  A 

1 

1 

6 

14 

37 

24 

9 

1 

1 (T) 

Adenoid 

1 

3 

1 

1 

Total 

2 

1 

6 

17 

37 

25 

10 

1 

1 

— 41  — 


SOUTH  DAKOTA 


TABLE  NO.  2 


AGE  DISTRIBUTION  IN  RELATION  TO  INDUCTION  TIME  (IN  MINUTES) 


Age 

Induction 

12-18  mo.  18-24  mo. 

2-3  yr. 

3-4  yr. 

4-6  yr. 

6-10  yr. 

10-15  yr. 

15-25  yr.  25  yr.-f 

Time 

4-6 

1 

2 

5 

1 

6-8 

2 

3 

7 

2 

8-10 

3 

3 

13 

6 

4 

10-12 

3 

9 

5 

1 

12-15 

2 

6 

2 

6 

5 

1 

15-18 

1 

4 

1 

18-21 

21-25 

25-30 

30-h 

1 

1 

Total 

2 1 

6 

17 

36 

25 

11 

1 1 

TABLE 

NO.  3 

DURATION 

OF  OPERATION  IN 

RELATION  TO 

SIDE 

AGE  AND  POSITION  OF  PATIENT 

BACK 

Duration  of  operation  in 

minutes 

Age 

4-71/2 

71/2-10 

10-121/2 

121/2-15 

15-171/2 

171/2-20 

20-25 

25-30 

30-35 

35-40 

12-18  mo. 

S 

1 

1 

B 

18-24  mo. 

S 

1 

B 

2-3  yr. 

S 

1 

1 

B 

1 

2 

1 

3-4  yr. 

S 

2 

2 

2 

3 

B 

1 

2 

4 

1 

4-6  yr. 

S 

5 

5 

3 

2 

1 

B 

3 

5 

6 

3 

1 

1 

1 

1 

6-10  yr. 

S 

4 

4 

4 

2 

1 

B 

1 

1 

3 

3 

1 

10-15  yr. 

S 

1 

2 

1 

B 

1 

2 

2 

2 

15-25  yr. 

S 

1 

B 

25  plus 

S 

1 

B 

TOTAL  5 18  20  29  10  7 4 4 2 1 


TABLE  NO.  4 

TIME  AVERAGES  (IN  MINUTES) 

Maximum  Minimum  Average 


Anesth.  induction 

30 

5 

11 

Op.  time 

40 

4 

14 

Total  anesth.  & op. 

time 

57 

14 

25 

Op.  time,  patient  on 

side 

34 

5 

13 

Op.  time,  patient  on 

back 

40 

4 

16 

Wake-up  time 

40 

15 

26 

At  the  conclusion  of  the  operation,  when 
the  patient  was  ready  for  transfer  to  the  post- 
operative ward,  bronchoscopy  was  done  and 
the  location  and  amount  of  blood,  mucus,  or 
foreign  material  in  the  bronchial  tree  was 
noted.  The  results  of  this  study  are  summar- 
ized in  Tables  6 through  11. 


— 42  — 


FEBRUARY  1958 

TABLE  NO.  5 

TOTAL  ANESTHETIC  TIME  (IN  MINUTES) 
IN  RELATION  TO  AGE  OF  PATIENT 


AGE 


12-18  mo.  18-24  mo. 

2-3  yr. 

3-4  yr. 

4-6  yr. 

6-10  yr. 

10-15  yr. 

15-25  yr.  25  yr.-j- 

TIME 

14-16 

2 

3 

3 

1 

1 

16-18 

2 

1 

4 

1 

18-21 

4 

10 

4 

1 

1 

21-25 

1 

4 

9 

8 

2 

25-30 

1 1 

1 

4 

7 

5 

2 

30-35 

1 

1 

5 

1 

35-40 

1 

1 

1 

1 

40-45 

1 

1 

45 

1 

2 

TOTAL 

2 1 

6 

17 

36 

25 

11 

1 1 

TABLE  NO.  6 TABLE  NO.  7 


OCCURRENCE  OF  BLOOD  IN  RELATION  TO 
POSITION  OF  PATIENT  AT  OPERATION 


POSITION 

With  Blood 

Without  Blood 

SIDE 

45 

5 

BACK 

47 

3 

TOTAL 

92 

8 

LOCATION  OF  BLOOD  OR  SECRETIONS  IN  THE 
BRONCHIAL  TREE  IN  RELATION  TO 


POSITION  OF  PATIENT 


POSITION 

Trachea 

Both  Main 
Bronchi 

SIDE 

40 

10 

BACK 

17 

43 

TABLE  NO.  8 


AMOUNT  OF  BLOOD  IN  RELATION 
TO  POSITION  OF  PATIENT 


Amount  of  Blood  (Cc.) 


MUCUS  TRACE 

.5-1.0  1-1.5 

1.5-2 

2-3 

3-4  4-5 

5-6 

6-7 

7 plus 

SIDE 

5 12 

10  12 

5 

1 

3 1 

1 

BACK 

3 4 

10  6 

8 

13 

3 

1 

1 

1 

TABLE  NO.  9 

PRESENCE  OF 

TRACHEAL  BLOOD  OR  MUCUS 

SIDE 

IN  RELATION  TO  AGE  OF  PATIENT 

BACK 

(Amt.  Blood 

in  Cc.) 

AGE 

12-18  mo. 

18-24  mo.  2-3  yr. 

3-4  yr. 

4-6  yr. 

6-10  yr.  10- 

■15  yr. 

15-25  yr. 

25  yr.-f 

MUCUS 

S 

4 

3 

1 

B 

1 

TRACE 

S 1 

4 

2 

1 

1 

B 

1 

1 

1 

.5-1.0 

S 1 

1 

2 

4 

3 

B 

1 

3 

7 

2 

1-1.5 

S 

2 

6 

4 

B 

1 

3 

2 

1.5-2 

S 

1 1 

1 

1 

B 

2 

3 

2 

1 

2-3 

S 

1 

B 

2 

1 

6 

4 

1 

3-4 

S 

2 

1 

B 

1 

1 

1 

4-5 

S 

1 

B 

5-6 

S 

1 

B 

1 

6-7 

S 

B 

1 

7 plus 

S 

B 

TOTAL 

2 

1 6 

17 

37 

24 

11 

1 

1 

— 43  — 


SOUTH  DAKOTA 


TABLE  NO.  10 

RELATION  OF  DURATION  OF  OPERATION 
TO  AMOUNT  OF  BLOOD 


SIDE 

BACK 


Operation  time 
(Min.) 

Amount  of  Blood 

(Cc.) 

MUCUS 

TRACE 

0.5-1.0 

1-1.5 

1.5-2 

2-3 

3-4 

4-5 

5-6  6-7 

7 plus 

4-71/2 

S 

1 

1 

B 

1 

1 

1 

7y2-io 

S 

3 

1 

4 

4 

B 

1 

1 

2 

3 

io-i2y2 

S 

1 

5 

3 

1 

1 

1 

B 

1 

3 

1 

2 

i2y2-i5 

S 

1 

3 

4 

2 

2 

1 

B 

2 

4 

4 

4 

2 

i5-i7y2 

S 

2 

1 

1 

1 

1 

B 

1 

2 

1 

171/2-20 

S 

1 

1 

B 

1 

2 

1 

20-25 

S 

1 

1 

1 

B 

1 

1 

25-30 

S 

1 

B 

1 

1 

1 

30-35 

S 

1 

B 

1 

35-40 

S 

B 

1 

TOTAL 

8 

14 

24 

16 

13 

14 

6 

1 

2 1 

1 

TABLE  NO. 

11 

RELATION  OF  TOTAL  ANESTESIA  TIME  TO  AMOUNT  OF  BLOOD 

SIDE 

BACK 

Anesthesia 

(Min.) 

Time 

Amount  of  Blood  (Cc.) 

MUCUS 

TRACE 

0.5-1.0 

1-1.5 

1.5-2 

2-3 

3-4 

4-5 

5-6  6-7 

7 plus 

10-15 

S 

1 

2 

B 

1 

1 

1 

1 

2 

15-20 

S 

3 

1 

4 

4 

1 

B 

1 

2 

1 

3 

20-25 

S 

1 

7 

5 

2 

1 

1 

2 

B 

7 

2 

3 

1 

1 

25-30 

S 

1 

1 

3 

2 

B 

1 

2 

3 

1 

5 

1 

30-35 

S 

1 

1 

1 

1 

1 

B 

1 

2 

1 

1 

35-40 

S 

B 

1 

2 

40 -f 

S 

1 

B 

1 

1 

1 

1 

TOTAL 

7 

15 

24 

18 

12 

13 

6 

1 

2 1 

1 

COMMENT:  Because  of  the  older  technique  one-half 

years. 

there 

have  been  no 

serious 

of  insufflation  anesthesia  for  adenotonsillec- 
tomy  has  been  severely  criticized  in  recent 
years  by  the  advocates  of  endotracheal  anes- 
thesia, we  have  attempted  to  evaluate  critically 
the  older  technique  of  anesthesia  to  deter- 
mine whether  the  purported  hazards  are  real. 
In  the  group  of  100  cases  evaluated  here,  in 
the  380  other  cases  which  were  done  during 
the  same  period  in  the  two  Sioux  Falls  hos- 
pitals, and  in  the  3572  cases  which  have  been 
done  in  these  hospitals  in  the  past  five  and 


complications  of  adenotonsillectomy  opera- 
tion or  anesthesia.  However,  it  must  be  noted 
that  the  majority  of  the  tonsil  and  adenoid 
operations  which  are  being  performed  in  this 
community  are  done  by  experienced  surgeons 
and  the  anesthetics  are  administered  by  anes- 
thetists who  have  had  good  training  and  fre- 
quent experience  with  this  procedure.  Both 
the  surgeons  and  the  anesthetists  were  very 
airway  conscious. 


— 44  — 


FEBRUARY  1958 


Many  of  the  glowing  reports  which  have 
appeared  in  the  literature  concerning  the 
merits  of  intubation  have  emanated  from 
teaching  institutions.  In  teaching  hospitals 
it  may  be  of  value  to  intubate  the  patients 
because  the  residents  in  anesthesia  and  oto- 
laryngology and  the  nurse  trainees  are  doing 
many  of  the  procedures  and  need  experience. 
Often  they  are  slower,  less  adept  and  more 
likely  to  have  trouble  during  this  operation. 
In  practice  the  surgeon  and  anesthetist  are 
usually  more  accurate  and  speedier. 

In  this  series,  blood  was  found  in  the  tra- 
chea or  the  main  bronchi  in  92%  of  the  cases 
examined  immediately  after  tonsillectomy. 
However,  in  89%  of  these  cases  this  was  less 
than  2.5  cc.  The  greatest  amount  of  blood  in 
the  trachea  was  11  cc.,  found  in  a 15-year-old 
boy.  There  was  no  significant  difficulty  noted 
during  this  series  maintaining  the  airway. 
Steel  and  Anderson^S)  reported  a study  of 
129  cases  in  which  the  tracheobronchial  tree 
was  aspirated  per  laryngoscope  with  silk 
catheters  following  adenotonsillectomy.  Fif- 
teen cubic  centimeters  of  blood  was  the 
greatest  amount  aspirated,  0.5  cc.  the  least; 
6.4%  of  the  patients  had  10  cc.  or  more;  20.8% 
had  5 cc.  or  more.  The  average  amount  of  en- 
dotracheal blood  was  3.7  cc.  Myerson,26) 
Harra®)  and  Iglauer'^)  reported  similar 
studies. 

In  the  post-tonsillectomy  patient,  one  of  the 
first  events  which  occur  as  he  awakens  is  a 
strong  cough,  with  which  any  blood  or  mucus 
is  brought  out.  In  this  large  group  of  patients 
we  found  no  significant  incidence  of  atelec- 
tasis or  pulmonary  complications  following 
the  insufflation  type  of  anesthesia,  suggest- 
ing that  the  cough  reflex  takes  care  of  en- 
dotracheal foreign  material.  The  results  of 
this  study  suggest  that  the  total  amount  of 
blood  actually  aspirated  during  adenoton- 
sillectomy is  small. 

Intubation  of  the  trachea  for  maintenance 
of  the  airway  is  not  without  hazard,  especially 
in  young  children.  This  age  group  usually 
comprises  the  majority  of  the  adenotonsillec- 
tomy procedures.  In  the  hands  of  the  inex- 
perienced anesthetist,  intubation  potentially 
carries  more  hazard  than  the  entire  operation. 

This  stand  regarding  the  subject  of  endo- 
tracheal intubation  for  tonsillectomy  might 
be  construed  as  a backward  step  in  the  safety 
program  of  anesthesia.  Yet,  after  a careful 


analysis  of  the  results  of  anesthesia  in  a large 
series  of  cases  done  by  proficient  surgeons  in 
this  community,  without  serious  complica- 
tions, it  becomes  apparent  that  the  insuffla- 
tion type  of  anesthesia  is  not  as  out-moded  as 
is  claimed.  The  complications  described  are 
not  seen  in  practice. 

After  reviewing  the  results  of  this  study 
and  the  reports  in  the  literature,  it  is  appar- 
ent that  for  the  usual  adenotonsillectomy  the 
choice  of  anesthetic  agent  and  technique  can- 
not be  categorically  and  dogmatically  stated. 
The  choice  must  be  governed  by  the  exper- 
ience of  the  anesthetist  and  the  surgeon,  the 
age  of  the  patient,  and  the  facilities  which  are 
available.  Although  improvement  in  the  air- 
way and  greater  safety  during  adenotonsillec- 
tomy in  children  are  attributed  to  endotra- 
cheal anesthesia  by  proponents  of  this  tech- 
nique, this  study  and  others,  involving  large 
groups  of  patients,  have  not  supported  the 
contention  that  anesthesia  without  a tube  in 
place  is  more  hazardous. 

BIBLIOGRAPHY 

1.  De  Tar,  J.  S.,  and  McKittrick,  L.  S.:  What 
Qualifies  a Doctor  to  Do  Surgery?  M.  Eco- 
nomics, p.  103,  March  1956. 

2.  De  Tar,  J.  S.,  in  Letters  to  the  Editor,  M.  Eco- 
nomics, pp.  45-47,  June  1956. 

3.  Who  Gives  Anesthesia?  News,  M.  Economics, 
p.  276,  Feb.  1956. 

4.  Wallner,  L.  J.:  An  Aid  to  Tonsillectomy  and 
Adenoidectomy  in  the  Head-Low  Position, 
A.M.A.  Arch.  Otolaryng.  63:299-300  (March) 
1956. 

5.  Moore,  P.  M.:  Tonsillectomy  Under  General 
Anesthesia,  Ann.  Otol.  Rhin.  & Laryng.  64: 
494-506  (June)  1955. 

6.  Harra,  H.  J.:  Aspiration  in  Tonsillectomy: 
Comparative  Merits  of  Posture  to  Other 
Factors,  California  & West.  Med.  33:628-638 
(Sept.)  1930. 

7.  Iglauer,  S.:  Aspiration  of  Blood  into  the  Lar- 
nyx  and  Trachea  During  Tonsillectomy  Under 
Local  Anesthesia:  A Contribution  to  the  Etio- 
logy of  Lung  Abscess,  Ann.  Otol.  Rhin.  & 
Laryng.  37:231-239  (March)  1928. 

8.  May,  R.  V.;  Thoburn,  T.  W.,  and  Rosenberger, 
H.  C.:  Aspiration  During  Tonsillectomy:  A 
Roentgenographic  Study,  J. A.M.A.  93:589-592 
(Aug.  24)  1929. 

9.  Hochfilzer,  J.  J.:  Endotracheal  Anesthesia  for 
Tonsillectomy,  South  Dakota  J.  Med.  & 
Pharm.  8:453-455  (Dec.)  1955. 

10.  Johnson,  F.:  Adult  Tonsillectomies  Using 
Pentothal  Sodium,  Curare,  Pontocaine  and 
Novocaine  as  the  Anesthetic,  Laryngoscope 
62:704-708  (July)  1952. 

11.  Stirling,  J.  B.:  Anesthesia  for  Tonsillectomy, 
Brit.  J.  Anaesth.  26:411-417  (Nov.)  1954. 

12.  Yinger,  S.  C.:  Tribromethanol-Ether  Anes- 
thesia Used  for  Tonsillectomy  and  Adenoidec- 
tomy, Arch.  Otolaryng.  50:290-294  (Sept.) 
1949. 

13.  Dickie,  J.  K.  M.:  Induction  of  Anesthesia  with 
Thiopental  Sodium  in  Tonsillectomy,  Arch. 
Otolaryng.  48:238-243  (Aug.)  1948. 

(Continued  on  Page  57) 


— 45  — 


REACTIONS  TO  TETANUS  ANTITOXIN; 
THEIR  ETIOLOGY.  PREVENTION  AND 
TREATMENT 
FRANK  M.  JAMES,  M.D. 
Broomfield  Heights,  Colorado 
and 

WALLACE  MARSHALL.  M.D. 

Two  Rivers,  Wisconsin 


So  many  patients  appear  to  be  experiencing 
a greater  occurence  of  those  reactions  to 
tetanus  antitoxin  sera.  This  increase  is  being 
witnessed  at  an  alarming  rate.''  Years  ago, 
such  reactions  were  more  an  exception  than 
the  rule,  but  recently,  many  a patient,  who 
has  been  given  this  material  hypodermically, 
is  more  than  merely  a potential  reactor  whose 
very  life  might  well  be  at  stake. 

It  is  not  necessary  to  call  the  attention  of 
our  readers  to  the  seriousness  of  such  abnor- 
mal atopic  reactions,  for  the  possibility  of 
death  might  ensue  unless  immediate  and 
proper  remedial  measures  are  instituted  just 
as  soon  as  such  reactions  can  be  noted  in  these 
patients.  Moreover,  it  is  highly  important  to 
use  adequate  prophylactic  measures  which 
will  be  mentioned  during  the  course  of  this 
paper.  It  is  mandatory  that  each  and  every 
patient,  who  receives  tetanus  antitoxin,  be 
warned  fully  about  what  possible  events 
might  be  expected  and  exactly  what  they 
should  do  immediately  should  these  events 
occur. 

Etiologic  Factors 

White  and  Ficarra''  wrote  recently  that 
“the  steady  increase  in  the  generalized  use  of 
certain  preservatives  in  foods,  the  ever  pop- 


ular use  of  vitamins,  plus  the  increased  use  of 
many  types  of  detergents  may  serve  to  pro- 
duce such  an  increase  (of  allergic  dermatoses). 
Furthermore,  the  marked  increase  in  the  use 
of  steroids  and  ataractic  drugs,  with  other 
synthesized  sedatives,  have  produced  many 
similar  allergic  responses  in  many  patients. 
It  is  a rare  event  to  find  a patient  who  has 
not  had  an  antibiotic,  the  sulfa-group  drugs, 
or  allied  preparations;  these  drugs  have  the 
decided  ability  to  oversensitize  and  to  pro- 
duce such  hyperallergic  manifestations.” 

Although  consideration  in  this  paper  is 
limited  to  tetanus  antitoxin  as  the  causative 
agent  for  producing  such  untoward  reactions 
in  hypersensitized  patients,  emphasis  should 
be  placed  upon  the  realization  that  many 
other  sensitizing  agents  can  produce  similar 
untoward  responses.  The  many  and  often 
used  medications  which  can  cause  such  dan- 
gerous reactions  are  penicillin,  the  sulfa 
drugs,  the  steroids,  to  merely  mention  but  a 
few  such  materials  among  almost  a countless 
number  of  other  sensitizing  agents  which  can 
produce  these  alarming  allergic  responses  in 
susceptible  patients. ^ TAT*  contains  horse 
serum,  which  is  a well-known  sensitizing 
agent  in  susceptible  individuals. 

*TAT  is  the  abbreviation  for  tetanus  antitoxin. 


— 46 


FEBRUARY  1958 


Since  so  many  young  men  and  women  have 
received  tetanus  toxoid  routinely  during  their 
induction  into  the  various  governmental 
armed  services,  there  is  the  possibility  that 
this  previously  injected  material  might  have 
sensitized  them  to  a later  injection  of  the  anti- 
toxin. The  tetanus  bacteria  in  the  toxoid 
preparation  might  have  set  up  systemic  re- 
actions which  might  be  involved  in  finally 
producing  an  atopic  reaction  upon  the  admin- 
istration of  a later  additional  dose  of  the 
tetanus  antitoxin.  It  is  well  constantly  to 
keep  in  mind  these  possible  dangerous  aller- 
gic reactions  whenever  a potential  allergenic 
substance  is  injected  into  the  body  of  any  pa- 
tient. The  physician’s  careful  and  constant 
consideration  of  these  possible  dangerous  re- 
actions will  keep  him  alert  so  proper  pre- 
cautions and,  if  necessary,  the  proper  treat- 
ment will  be  available  at  all  times  to  treat 
immediately  such  untoward  reactions  should 
they  occur  unfortunately. 

Etiologic  Factors 

When  tetanus  antitoxin  is  injected  into  a 
previously  hypersensitized  patient,  the  prob- 
ability of  three  separate  types  of  allergic  re- 
actions are  possible.  The  fastest  type  is  the 
immediate  reaction.  This  untoward  response 
of  the  human  individual  to  the  administration 
of  tetanus  antitoxin  is  observed  from  almost 
an  immediate  response  to  a reaction  which 
can  be  noted  within  24  hours  after  the  injec- 
tion was  administered. 

The  reader’s  attention  is  called  to  the  pre- 
ventive measure  of  giving  beforehand  an  in- 
tracutaneous  very  small  about  (0.1  cc.)  of 
the  antitoxin  in  the  ventral  portion  of  the 
patient’s  forearm  prior  to  the  administration 
of  the  regular  dose  of  tetanus  antitoxin.  If 
the  patient  is  sensitive  to  this  material,  an 
erythematous  halo  will  surround  the  injec- 
tion site.  Particularly  in  those  sensitive  pa- 
tients, this  erythematous  halo  will  also  have 
raised  pseudopods  which  extend  away  from 
the  halo  periphery.  Usually  this  area  itches. 

However,  the  authors,  even  by  performing 
the  above  intracutaneous  test,  have  observed 
previously  sensitized  patients  who  did  not 
show  such  intradermal  reactions  but  who 
later  developed  severe  generalized  allergic 
reactions.  In  other  words,  this  intracutaneous 
test  is  not  too  accurate  a warning  procedure, 
so  that  the  physician  can  not  become  com- 
placent about  his  patients  ever  developing 


reactions  to  injected  tetanus  antitoxin. 

If  the  patient  reacts  to  the  intracutaneous 
test,  the  usual  procedure  is  to  administer  the 
remaining  antitoxin  in  subsequent  multiple 
small  doses  and  allowing  adequate  time  in- 
tervals between  such  injections.  A sterile 
syringe  containing  the  contents  of  an  am- 
poule of  1:1000  dilution  epinephrine  Hcl  is 
kept  handy  for  immediate  use  should  such  an 
emergency  arise. 

For  some  unexplained  physiologic  reason, 
tetanus  antitoxin,  in  susceptible  patients, 
produces  itching  which  later  is  accompanied 
by  dryness  of  the  mouth  and  throat,  and  the 
formation  of  hives  and  markedly  erythema- 
tous patches  on  the  body.  This  skin  involve- 
ment resembles  those  dermatologic  findings 
which  are  observed  with  cases  of  erysipelas. 
If  allowed  to  persist  and  to  go  without  proper 
therapy,  such  patients  may  well  develop 
laryngeal  edema  and  cyanosis  with  the  possi- 
bility of  death  which  might  ensue.  Many  pa- 
tients with  such  a laryngeal  involvement  have 
been  saved  by  the  immediate  performance  of 
a tracheotomy  with  a jack-knife  when  other 
therapeutic  measures  have  not  been  available 
for  one  reason  or  another. 

The  second  type  of  allergic  reaction  to 
tetanus  antitoxin  is  the  intermediate  reaction. 
This  occurs  from  7 to  12  days  after  the  anti- 
toxin was  administered.  The  third  type  is  the 
latent  or  the  chronic  type  which  is  observed 
about  30  days  following  the  original  adminis- 
tration of  antitoxin. 

One  particular  observation  of  importance, 
which  accompanies  the  above  3 types  of  al- 
lergic responses,  is  that  the  intradermal  site 
and  also  the  administration  site  both  tend  to 
become  erythematous  and  begin  to  itch  in- 
tensely. The  antitoxin  has  injured  apparently 
the  microcirculation  in  these  areas  so  that  a 
marked  vasodilation  takes  place  within  these 
terminal  skin  vessels.  A decided  increase  in 
the  capillary  permeability  takes  place  in 
these  previously  injured  blood  vessels,  the 
venous  pressure  rises  markedly  also,  and 
then  the  formation  of  edema  occurs.  As  the 
fluid  leaves  its  former  container  and  invades 
the  adjacent  tissue,  it  impinges  upon  the 
nerve  endings.  This  action  produces  a de- 
cided amount  of  itching,  swelling  of  the  area, 
redness,  with  a definite  increase  in  the  forma- 
tion of  heat  (the  area  becomes  hot),  and  the 
involved  structures  tend  to  lose  their  phys- 


— 47  — 


SOUTH  DAKOTA 


iologic  abilities  and  functions. 3 All  these 
signs  are  those  which  are  associated  with  in- 
flammation, which  is  the  main  pathologic 
process  involved  with  such  bodily  reactions 
to  tetanus  antitoxin.  In  this  study,  antitoxins 
from  four  pharmaceutical  manufacturers 
were  employed  with  identical  reactions. 

In  our  series  of  patients,  about  one-third 
of  all  the  patients,  who  were  given  tetanus 
antitoxin,  had  such  reactions.  80%  were  of 
the  intermediate  type,  and  the  remaining 
20%  were  latent  in  nature  (30  day  type). 
There  were  no  immediate  reactions.  This  was 
due  to  the  fact  that  we  learned  through  long 
experience,  that  Kutapressin,*  when  admin- 
istered in  an  opposite  arm  area,  and  in  a 
separate  syringe,  has  the  decided  ability  of 
protecting  those  patients  from  the  immediate 
type  of  tetanus  antitoxin  reactions.  This  pro- 
tecting action  of  this  preparation  apparently 
does  not  last  long  enough  to  shield  the  pa- 
tients from  the  intermediate  and  the  latent 
types  of  reactions.  However,  just  as  soon  as 
each  patient  noted  itching  accompanied  pos- 
sibly by  erythema  and  edema  of  the  previous 
injection  sites,  another  injection  of  Kutapres- 
sin was  administered  immediately.  The  ad- 
ditional amount  of  this  drug  adequately  pro- 
tected each  patient  from  further  TAT  re- 
actions. 80  consecutive  cases  were  given 
Kutapressin  with  the  regular  injection  of 
Tetanus  antitoxin  (in  separate  arms)  just  as 
soon  as  the  intradermal  (intracutaneous) 
testing  of  TAT  was  completed.  This  pro- 
cedure was  followed  carefully,  because  it  had 
been  discovered  that  a preliminary  dose  of 
Kutapressin  (2  cc.  dose  subcutaneously)  had 
the  ability  to  mask  the  TAT  intradermal 
sensitivity  reaction  by  preventing  the  forma- 
tion of  erythema  and  edema  in  those  patients 
who  were  known  definitely  to  be  sensitive  to 
this  allergenic  material  (TAT). 

Treatmenl 

There  has  been  a natural  tendency  on  the 
part  of  some  colleagues  to  discount  our  sug- 
gestion that  Kutapressin  be  substituted  for 
the  rather  dangerous  and  promiscuous  use  of 
epinephine  HCL  for  the  therapy  of  TAT  re- 
actions of  all  types.  Our  colleagues  appar- 
ently do  not  desire  to  run  the  risk  of  death  to 
any  patient  by  withholding  the  immediate 

*Kutapressin,  a derivative  of  the  liver,  is  manu- 
factured by  the  Kremers-Urban  Company  of  Mil- 
waukee. 


use  of  epinephrine  in  such  serious  allergic 
responses  in  their  patients.  Kutapressin  will 
not  raise  a patient’s  systemic  blood  pressure, 
because  this  drug’s  action  is  confined  only 
to  the  previously  markedly  dilated  terminal 
blood  vessels. 4 Kutapressin  is  wholly  non- 
toxic and  non-allergenic,  so  it  can  be  employed 
without  any  known  contraindications.  We 
have  treated  patients  who  were  in  shock  with 
the  use  of  Kutapressin  and  who  had  de- 
veloped severe  laryngeal  edema,  due  to  TAT 
reactions.  The  usual  dose  is  2 cc.  given  sub- 
cutaneously or  intramuscularly.  Such  coma- 
tose patients  usually  recover  sufficiently 
within  a period  of  5 to  15  minutes  after  this 
administration  of  Kutapressin.  One  does  not 
have  to  worry  about  a latent  drop  in  systemic 
blood  pressure  which  certainly  has  been 
known  to  happen  following  the  use  of  epine- 
phrine Hcl.  No  rise  in  systemic  blood  pres- 
sure has  to  be  considered  when  Kutapressin 
is  used  as  is  the  case  with  epinephine  Hcl. 
Furthermore,  the  physician  does  not  have  to 
worry  about  the  untoward  release  of  glucose 
which  sometimes  follows  the  use  of  epine- 
phrine Hcl  in  diabetic  patients,  and  which 
might  produce  marked  glycosuria  with  the 
possibility  of  diabetic  coma  in  susceptible 
diabetic  patients.  Additional  and  subsequent 
doses,  in  2 cc.  amounts  of  Kutapressin,  can  be 
administered  with  complete  safety  to  those 
patients  who  have  reacted  violently  to  TAT. 
As  much  as  10  cc.  in  a single  dose  of  this 
drug  has  been  administered  safely  to  a severe 
case  of  gastric  hemorrhage. 

The  writers  have  been  firm  believers  of  the 
old  dictum  of  employing  the  least  harmful 
medications  rather  than  those  heroic  med- 
ications which  might  prove  to  be  far  more 
harmful  to  a patient  than  even  the  disease 
which  is  being  treated.  This  situation  can  be 
exemplified  adequately  by  the  tendency  of 
some  clinicians  to  employ  the  more  danger- 
ous drugs  when  a far  less  dangerous  medica- 
tion might  well  be  employed.  Such  has  been 
the  experience  with  the  promiscuous  use  of 
the  steroids  and  the  anti-coagulants  5 to 
merely  cite  a few  such  examples  which 
readily  come  to  mind. 

Summary 

The  most  important  etiologic,  preventive 
and  therapeutic  aspects  associated  with  those 
reactions,  are  discussed  which  are  precipitated 
(Continued  on  Page  51) 


— 48  — 


THE  TREATMENT  OF  EMOTIONAL 
DISTURBANCES  IN  CHILDREN 
Jerman  Rose,  M.D.,  Omaha,  Nebraska 


As  a result  of  his  evaluation,  the  phys- 
ician may  have  concluded  that  the  child  has 
a problem  which  may  be  best  dealt  with  by 
special  community  resources  or  he  may  use 
these  resources  in  conjunction  with  his  own 
therapy.  Certain  special  educational  prob- 
lems may  require  engaging  a warm,  patient 
and  understanding  tutor.  People  troubled  by 
marital  difficulties  may  be  referred  to  one  of 
the  social  agencies  such  as  the  Family  Service 
Society.  Most  fairly  large  cities  have  such 
agencies  which  usually  have  on  their  staff 
trained  psychiatric  social  workers,  many  of 
whom  have  great  skill  in  helping  troubled 
people  deal  more  effectively  with  their  en- 
vironment. Speech  problems  should  be  re- 
ferred to  a speech  therapist.  However,  it 
should  be  emphasized  that  children  who 
stammer  or  stutter  almost  always  have  an 
emotional  problem  with  which  they  need 
help.  Psychotic  and  other  severaly  disturbed 
children  are  best  referred  to  a psychiatrist. 
Successful  referral  is  an  important  part  of  the 
treatment.  It  is  paradoxical  that  families 
who  need  psychiatric  help  the  most  are  the 
most  difficult  to  refer.  They  sometimes  meet 
suggested  referral  with  great  hostility  and 
resentment.  They  may  be  so  incensed  that 
they  seek  help  from  another  physician  be- 
cause you  seem  to  have  inferred  they  are 
crazy.  Even  so,  it  seems  advisable  in  the  in- 
terest of  good  treatment  to  lose  the  patient 

^Presented  at  the  76th  Annual  Meeting  of  the 
South  Dakota  State  Medical  Association,  Tuesday 
May  21st,  1957. 


that  will  not  follow  your  recommendations 
rather  than  to  carry  them  along  with  treat- 
ment which  will  not  help  the  problem.  Others 
feel  somewhat  deserted  when  you,  who  have 
so  adequately  cared  for  them  through  the 
years,  indicate  to  them  that  you  cannot  help 
them  now.  It  is  difficult  to  say  how  referral 
can  best  be  made  because  each  of  us  has 
worked  out  a method  which  works  best  for 
us.  It  should  be  added  that  those  physicians 
who  believe  that  psychiatric  treatment  can 
help  are  most  successful  in  their  referrals. 

If  the  general  physician  decides  to  treat  the 
problem  himself,  he  should  be  aware  of  the 
fact  that  treatment  directed  toward  the  symp- 
tom alone  is  not  usually  enough.  Certain 
kinds  of  symptomatic  treatment  are  psycho- 
logically harmful,  and  are  worse  than  no 
treatment  at  all.  Splinting  a youngster’s  arm 
to  keep  him  from  sucking  his  thumb  is  not 
going  to  help  him  to  satisfy  the  needs  which 
he  is  trying  to  tell  us  about  by  sucking  his 
thumb.  The  use  of  one  of  these  infernal  elec- 
trical devices  designed  to  give  a child  an 
electric  shock  when  he  wets  his  bed  is  cer- 
tainly not  going  to  help  the  child  grow  up 
with  the  feeling  that  the  world  is  a pretty 
nice  place  to  be  in.  Contrary  to  other  fields 
of  medicine,  drugs  are  not  usually  helpful. 
The  use  of  sedatives,  narcotics  or  tranquil- 
lizers in  the  abscence  of  demonstrable  phys- 
ical disorders  may  have  a delecterious  effect 
on  an  anxious  child.  The  child  may  already 
be  puzzled  by  his  poorly  understood  feelings 


— 49  — 


SOUTH  DAKOTA 


and  the  drugs  may  add  other  more  puzzling 
feelings.  Drugs  may  also  interfer  with  the 
mobilization  of  the  child’s  adaptive  capacities 
which  will  help  him  to  cope  with  his  problem. 

Successful  treatment  of  emotional  distur- 
bances in  children  depends  on  the  doctor- 
patient  relationship  more  than  in  any  other 
area  of  medicine.  Indeed,  the  doctor’s  per- 
sonality and  his  relationship  to  the  patient 
are  his  main  therapeutic  tools.  How  can  the 
physician  use  this  relationship  to  catalyze  the 
emotional  growth  of  his  young  patients? 
Some  feel  that  simply  reporting  to  the  par- 
ents the  major  factors  in  their  relationship  to 
the  child  which  have  led  to  the  problem  re- 
sults in  the  resolution  of  the  problem,  or,  at 
least,  motivates  the  family  to  do  something 
about  resolving  the  problem  themselves. 
Further  research  may  confirm  or  deny  the 
effectiveness  of  this  approach. 

Others  feel  that  it  is  advisable  to  spend 
several  interviews  with  the  child  or  his  par- 
ent or  both  in  order  to  help  them  to  resolve 
their  problem.  As  in  other  areas  of  medicine, 
the  patient’s  trust  in  his  physician  is  of 
prime  importance.  Patients  have  this 
trust  in  their  family  doctor  which  places 
him  in  a particularly  strategic  position  to 
help.  Even  the  child  who  has  been  hurt  phys- 
ically by  the  physician  in  the  course  of  the 
administration  of  needed  injections  will  have 
this  trust  if  the  physician  has  been  honest 
with  him  and  hasn’t  said,  “This  won’t  hurt,” 
when  he  gives  an  injection.  In  order  not  to 
violate  this  trust,  it  is  best  to  see  parent  and 
child  separately  once  therapy  has  begun  and 
great  care  should  be  exercised  not  to  reveal 
to  either  the  confidences  of  the  other.  If  one 
is  to  work  with  both  parent  and  child,  it  is 
frequently  difficult  not  to  take  sides  in  which 
case  one  gets  caught  in  the  middle  of  the 
family  conflict.  Because  of  this  fact,  it  is 
sometimes  wise  to  refer  either  the  child  or 
the  parent  to  a colleague.  However,  it  is  not 
suggested  that  one  be  neutral  in  the  thera- 
peutic relationship.  The  physician  who  enters 
into  this  relationship  with  interest  in  this 
person  who  needs  him  and  sees  in  the  rela- 
tionship the  possibility  of  a gratifying  ex- 
perience for  both  himself  and  the  patient  is 
most  likely  to  help  his  patient.  The  physician 
who  enters  this  relationship  with  the  idea  of 
finding  out  who  in  the  family  is  wrong,  or 
with  the  idea  of  arguing  the  patient  into  his 


point  of  view  is  not  likely  to  be  successful  in 
his  treatment.  The  physician’s  role  is  that  of 
participant-observer;  the  patient  uses  him  as 
a proving  ground  for  unacceptable  (to  them) 
feelings,  ideas,  and  actions.  Acceptance  and 
understanding  of  these  feelings  may  lead  to 
greater  self-acceptance  on  the  part  of  the 
patient  and  may  result  in  the  release  of  en- 
ergy, which  has  been  bound  up  in  conflicts, 
for  more  productive  activity. 

Dr.  Frederick  H.  Allen,  and  the  Phila- 
delphia Child  Guidance  Clinic,  wrote  the 
following  words  in  1934,  regarding  the  thera- 
peutic relationship: 

“I  am  more  nearly  able  to  respect  the  in- 
tegrity of  those  who  come  to  me  for  treat- 
ment, thus  enabling  them  to  come  closer  to 
being  themselves  in  their  relation  with  me, 
without  the  evasions  and  projections  that 
have  retarded  their  emotional  growth.  The 
capacity  to  accept  a child  or  adult  as  he  is, 
without  an  urge  to  recreate  him,  or  to  take 
over  his  own  responsibility  for  living,  is  in- 
dicative of  my  respect  for  his  capacity  to 
work  on  his  own  problem,  and  to  achieve  a 
healthier  expression  of  himself  thru  the 
type  of  relation  I enable  him  to  have  with 
me  as  a therapist.  I have  no  desire  to  im- 
pose my  own  standards  upon  a patient  or 
to  determine  the  specific  attitudes  toward 
which  the  therapy  will  be  directed.  If  I can 
create  a relation  in  which  the  child  or  adult 
feels  that  he  is  accepted  at  the  point  he  is 
in  his  own  growth  — rebellious,  hostile, 
fearful,  or  what  not  — then  that  person  has 
an  opportunity  to  go  ahead  with  those  dif- 
ficulties that  are  most  concerning  him.  He 
is  not  kept  busy  defending  himself  against 
being  ‘helped’  and  being  remade.” 

“The  second  principle  that  applies  to  my- 
self is  an  outgrowth  of  the  first.  In  therapy, 
I make  fewer  and  fewer  pretenses  that  I am 
invested  with  certain  omnipotent  powers 
that  sometimes  are  assumed  by,  and  some- 
times assigned  to,  the  psychiatrist.  Grad- 
ually, I am  coming  to  recognize,  and,  what 
is  more  important,  accept  without  apology 
my  limitations  in  reshaping  the  feelings 
and  behavior  of  another.” 

1.  Allen,  Frederick  H.;  American  Journal  of 
Orthopsychiatry,  Vol.  IV,  No.  2,  April,  1934. 


— 50  — 


FEBRUARY  1958 


In  the  course  of  general  medical  practice, 
the  physician  develops  skills  in  interviewing 
which  enable  him  to  obtain  a history  from  a 
patient  with  a minimum  of  time  expenditure 
and  a minimum  of  effort.  The  physician’s 
and  the  patient’s  purpose  is  to  get  to  the  root 
of  the  problem  as  quickly  as  possible.  The 
patient  with  an  emotional  problem  also  wants 
to  get  rid  of  his  pain  as  quickly  as  possible 
but  he  is  afraid  that  the  facing  of  his  problem 
may  cause  more  pain  than  he  is  now  exper- 
iencing. In  the  case  of  palpating  a tender 
abdomen,  the  point  of  greatest  tenderness 
should  be  approached  gently.  In  the  psy- 
chitric  interview,  problem  areas  should  also 
be  approached  gently  so  that  the  patient  will 
dare  to  discard  his  defense  mechanisms  and 
face  the  anxiety-ridden  conflictual  areas  of 
his  personality.  The  rapidity  with  which  the 
physician  approaches  these  areas  is  deter- 
mined more  by  feeling  tones  and  non-verbal 
cues  than  by  the  actual  verbal  content  of  the 
interview.  For  example,  many  of  our  patients 
will  relate  with  great  hesitancy  and  em- 
barrassment some  incident  to  feel  guilty 
about.  Recognition  of  their  feelings  of  guilt 
and  self-condemnation  is  more  helpful  than 
laughingly  reassuring  them. 

As  a general  rule,  one’s  interpretations 
should  be  feeling  oriented  rather  than  an  at- 
tempt to  familiarize  the  patient  with  the 
logical  explanations  of  his  psychodynamics. 
With  both  children  and  adults,  the  patient’s 
emotional  experience  in  his  close  relationship 
with  his  physician  is  the  therapeutic  elixir. 

With  young  children,  toys  are  used  as  a 
means  of  communication.  Children  use  their 
play  to  release  tensions  and  to  express  the 
way  they  feel  about  themselves  and  the 
world  around  them  as  well  as  for  purposes  of 
enjoyment.  In  play  therapy,  the  physician 
verbally  enters  into  the  child’s  fantasy  about 
the  toys  and  discusses  with  the  child  how  the 
toys  feel  about  being  placed  in  the  various 
situations  the  child  places  them  in  as  if  they 
were  real  incidents  in  the  everyday  world. 
Thus  a “make-believe  world”  is  created  in 
which  the  child  can  release  feelings  which  he 
dare  not  admit  to  the  “real  world.” 

A detailed  account  of  the  specialized  tech- 
niques sometimes  utilized  in  the  treatment 
of  the  emotionally  disturbed  child  has  been 
purposely  avoided  in  this  brief  discussion  be- 
cause the  physician  who  is  interested  will 


devise  techniques  of  his  own  if  he  is  sensitive 
enough  to  allow  his  young  patients  to  guide 
him  in  letting  him  know  when  they  are  ready 
to  face  their  problems.  It  is  hoped  that  more 
general  physicians  will  allow  themselves  the 
luxury  of  becoming  involved  in  therapuetic 
relationships  which  consist  of  using  only 
themselves.  It  really  is  fun. 


REACTIONS  TO  TETANUS  ANTITOXIN 
THEIR  ETIOLOGY,  PREVENTION  AND 
TREATMENT^ 

(Continued  from  Page  46) 
by  the  use  of  tetanus  antitoxin.  Although 
epinephrine  Hcl  is  used  universally  at  this 
time,  it  was  found  that  Kutapressin  could  be 
substituted  adequately,  thereby  reducing  the 
possibilities  of  untoward  reactions  from 
epinephrine  Hcl.  No  harmful  side  reactions 
have  ever  been  reported  from  the  use  of 
Kutapressin  in  allergic  responses  or  with 
those  other  diseases  which  have  been  treated 
with  this  unique  and  safe  microcirculatory 
constrictor. 

It  has  been  demonstrated  that  those  integu- 
mental  allergic  responses  are  caused  by  the 
markedly  dilated  microcirculatory  structures 
(terminal  circulation).  The  specific  constrict- 
ing action  of  Kutapressin  on  these  markedly 
dilated  circulatory  vessels  controls  such  un- 
toward responses  adequately  and  safely  with- 
in a matter  of  minutes.  These  hypersensitive 
responses  should  have  the  physician’s  im- 
mediate and  constant  attention  in  order  to 
avert  the  possibility  of  death  to  such  a pa- 
tient who  is  suffering  severly  from  an  atopic 
reaction. 

REFERENCES 

(1)  White,  C.  J.  and  Ficarra,  B.  J.:  Use  of  Kuta- 
pressin for  therapy  of  allergic  dermatoses  in 
elderly  patients.  To  be  published  in  the 
Journal  of  the  American  Geriatrics  Society. 

(2)  Marshall,  W.:  Treatment  of  sensitivity  re- 
actions with  new  non-toxic  vasoconstrictor. 
Indian  J.  Venereal  D.  and  Derm.  (Bombay, 
India)  20:99,  1954. 

(3)  Ibid:  Inflammatory  edema  accompanying 
microcirculatory  disease  and  its  specific  ther- 
apy with  microcirculatory  construction.  Miss. 
Valley  M.  J.  79:202,  1957. 

(4)  Ficarra,  B.  J.  and  Marshall,  W.:  New  concept 
on  pathogenesis  and  therapy  for  early  benign 
prostatic  hypertrophy:  A disease  of  the  micro- 
circulation  treated  with  Kutapression.  To  be 
published. 

(5)  Marshall,  W.:  Medical  therapy  for  superficial 
phlebitis,  phlebothrombosis  and  thrombo- 
phlebitis. Ariz.  Med.  88:551,  1955. 


— 51  — 


9 


OBSTETRIC 
CASE  STUDY 
R.  E.  Staats,  M.D. 
Winner,  S.  D.* 


This  20  year  old,  white,  married.  Catholic 
female,  Mrs.  M.  E.  L.,  began  her  prenatal 
visits  for  this  pregnancy  on  13  Dec.  54.  Her 
last  normal  menstrual  period  had  begun  13 
Oct.  54.  She  had  had  one  known  pregnancy 
ending  14  June  54  with  spontaneous  abortion 
followed  by  curretage.  Her  post  operative 
course  had  been  uneventful.  During  the  year 
preceeding  this  pregnancy,  Mrs.  M.  E.  L.  had 
very  frequent  episodes  of  pyuria  of  un- 
determined etiology.  Urological  consultation 
was  unrevealing,  but  after  considerable  anti- 
biotic and  chemotherapeutic  courses,  she  be- 
came infrequently  symptomatic  following 
Oct.  54.  The  remainder  of  her  past  history  is 
not  significant.  The  family  history  was  con- 
tributory in  the  multiparity  of  the  patient’s 
mother,  Grava  13  Para  13,  and  twins  on  both 
sides  of  the  family.  The  husband  was  a fra- 
ternal twin.  The  menstrual  history  was  nor- 
mal. The  physical  examination  revealed  a 
small,  alert,  .cooperative,  healthy  girl  with 
uterine  enlargement  to  a level  of  a two 
months  pregnancy.  The  pelvis  was  small 
gynecoid  with  no  abnormalities  of  the  genital 
tract.  Her  height  was  59  inches,  weight  114 
lbs.,  BP  110/60,  Hb  12.0  gm,  urine  normal, 
V.D.R.L.  negative,  and  Rh  positive.  Mrs. 
M.  E.  L.’s  prenatal  course  was  as  followed: 
9 Feb.  55  Fundus  at  umbilicus,  no  fetal  heart 
tones  heard,  urine  negative,  BP  120/60,  Wt. 
115.  Complained  of  moderate  insomnia.  Rx 
* Dr.  Staats  is  now  located  at  San  Antonio,  Texas. 


continue  Naialins  t.i.d.,  and  was  told  to  take 
an  occasional  Nembutal  gr  % h.s.  15  Feb.  Pa- 
tient complained  of  painful  Thrombosed 
Hemorrhoid  and  discomfort  in  both  inguinal 
regions.  Rx  hot  Sitz  baths  and  Codeine  gr 
14  q.i.d.  p.r.n.  pain  9 Mar.  Fundus  one  finger- 
breadth  above  the  umbilicus,  no  F.H.T.  heard, 
urine  negative,  BP  120/60,  Wt.  121,  three 
episodes  of  mild  epistaxis,  felt  well.  2 April 
Mrs.  M.  E.  L.  was  admitted  to  the  hospital 
for  observation  with  complaints  of  lower  ab- 
dominal pain  and  faintness.  Physical  exam- 
ination was  normal,  Hb  10.8,  R.B.C.  3.9  mil- 
lion, W.B.C.  15,500.  N 69%,  L 29%,  E 1%, 
B 1%,  urine  normal  except  that  a few  pus 
cells  were  noted.  She  remained  afebrile 
throughout  her  hospital  course  of  three  days. 
She  received  Liver  1 cc,  Iberol  t.i.d.  p.c., 
phenobarbital  gr  ss  q.6  h.,  and  was  discharged 
asymptomatic  with  the  diagnoses  of  Hypoten- 
sion of  Pregnancy  and  Pressure  Pains  Lower 
Abdomen  of  Pregnancy.  4 April  The  Throm- 
bosed Hemorrhoids  were  emptied  surgically 
as  Mrs.  M.  E.  L.  had  painful  recurrence  of 
her  symptoms.  Her  post  operative  course  was 
uneventful.  13  April  F.H.T.  heard  in  the 
L.L.Q.,  position  and  presentation  were  not 
determined,  urine  negative,  BP  130/60,  Wt. 
125,  Hb  11.5  gm.  10  May  F.H.T.  heard  L.L.Q., 
position  and  presentation  undetermined, 
fundus  two  fingerbreadths  above  the  um- 
bilicus, BP  110/60,  urine  negative,  Wt.  128, 
Hb  11.0  gm.  2 8May  Urine  indicated  more 


— 52  — 


FEBRUARY  1958 


than  “normal”  pus  cells,  Wt.  132,  BP  130/60. 
Rx  to  force  fluids  at  least  three  measured 
quarts  daily.  8 June  F.H.T.  again  auscultated 
in  the  L.L.Q.,  presentation  and  position  not 
I determined,  the  impression  of  moderate 
I polyhydramnios  was  recorded,  urine  negative, 

I Wt.  133,  BP  120/70.  10  June  The  Patient  was 
i admitted  to  the  hospital  at  10:00  a.m.  follow- 
i ing  spontaneous  rupture  of  her  membranes 
! at  home.  Examination  at  this  time  gave  the 
impression  of  two  heads  in  the  upper  abdo- 
men. This  was  the  first  indication  of  twins 
1 found  and  x-ray  revealed  double  breech 
presentation  not  at  term.  She  received  no 
medication  until  13  June  when  Pitocin  intra- 
j muscularly  at  half  hour  intervals  in  incre- 
ments of  one  minim,  two  minims,  and  two 
minims  was  given  resulting  in  irregular  mild 
uterine  contractions.  Since  the  amniotic  fluid 
continued  to  flow  slowly,  the  patient  was 
started  on  Penicillin  and  Triple  Sulfa.  Labor 
did  not  begin,  so  she  was  discharged  home  on 
limited  activity.  Triple  Sulfa,  and  close  ob- 
servation on  15  June  with  instructions  to  call 
for  house  visits  if  any  change  was  noted  in- 
cluding a malodorous  vaginal  discharge, 
fever,  discontinued  amniotic  fluid  flow, 
labor  etc. 

In  our  practice  we  necessarily  care  for 
nearly  all  Obstetric  complications  as  our 
closest  Obstetrician  is  about  200  miles  distant; 
however,  the  combination  of  double  breech 
presentation,  ruptured  membranes,  and  a 
non-laboring  primipara  five  weeks  from  term 
required  advice  from  a highly  experienced 
specialist,  and  Dr.  Paul  A.  Bruns  of  the  Uni- 
versity of  Colorado  was  contacted.  Dr.  Bruns 
advised  a conservative  course  and  kindly  fol- 
low’ed  this  case  by  telephone. 

On  21  June  the  patient  observed  bloody 
show  and  scattered  uterine  contractions  mild- 
ly painful;  consequently,  she  was  admitted 
again  to  the  hospital  at  10:00  a.m.  for  observa- 
tion. She  was  begun  on  Terramycin  at  ad- 
I mission.  After  continuous  but  desultory  labor 
for  three  days,  the  patient  was  given  one  am- 
pule of  Pitocin  in  1000  cc  5%  Glucose  in  water 
by  controlled  intravenous  administration 
I with  only  the  development  of  “Pit  pains.” 
At  7:00  p.m.  24  June  the  I.V.  was  repeated 
with  apparently  much  the  same  results  dur- 
ing the  administration;  however,  the  irreg- 
' ular  contractions  were  somewhat  more 
strenuous  and  did  not  fade  away  entirely. 


These  contractions  tired  the  patient  consid- 
erably, and  she  was  given  Nisentil  20  mgm 
at  midnight  and  4:00  a.m.  25  June  which  al- 
tered labor  but  little  and  allowed  her  to  rest 
well  between  contractions  which  were  about 
8-10  minutes  apart.  At  10:30  a.m.  it  was 
noted  that  her  labor  began  to  shorten  inter- 
val and  lengthen  duration.  Sterile  vaginal 
examination  at  2:30  p.m.  revealed  absence  of 
purulent  discharge  in  spite  of  temperature 
elevation  to  101.2,  cervix  dilated  5 cm,  75% 
effaced,  and  both  heels  of  the  left  baby  thrust 
deeply  into  the  vagina  pressing  against  the 
sacrum  and  the  buttocks  apparently  resting 
on  the  pelvic  brim.  This  labor  never  came  to 
good  quality  and  short  regular  interval  and 
was  considered  a type  of  delayed  Pitocin  in- 
duction. At  11:01  p.m.,  under  pudendal  block 
and  whiffs  of  Nitrous  Oxide,  delivery  was 
effected  through  wide  episiotomy  with  appli- 
cation of  forceps  to  the  after  coming  head. 
The  second  bag  of  waters  was  ruptured 
mechanically  immediately  and  the  second  girl 
delivered  similarly.  Both  babies  cried  spon- 
taneously, immediately,  and  well.  They 
weighed  5 lb.  V-k  oz.  and  4 lb.  13  oz.  Follow- 
ing delivery  the  mother  was  given  another 
1000  cc  5%  Glucose  in  water  with  an  ampule 
of  Pitocin  added  to  combat  mild  uterine 
atony  and  exhaustion.  The  post  partum 
courses  of  the  mother  and  children  were  un- 
eventful. The  mother’s  third  post  portion  day 
Hb  was  11.8  gm. 

DISCUSSION 

This  twin  pregnancy  was  missed 
until  late  in  spite  of  suggestive  history  and 
rapidly  rising  uterus  was  readily  diagnosed 
after  loss  of  amniotic  fluid.  As  was  previously 
mentioned,  the  patient’s  temperature  grad- 
ually rose  during  the  final  hospitalization  to 
delivery  giving  considerable  apprehension. 
However,  at  delivery  there  were  no  signs  of 
infection  and  the  temperature  returned  to 
normal  when  fluid  was  replaced.  The  un- 
proved pelvis  was  considered  adequate  for  a 
small  average  baby  by  normal  presentation 
but  questionable  for  an  average  weight  baby 
by  breech.  Hence,  the  desire  for  small  babies 
not  premature  by  weight  led  to  the  probably 
ill  advised  token  intramuscular  Pitocin.  Hap- 
pily the  medication  at  that  time  produced  no 
demonstrable  effect  although  it  may  have 

(Continued  on  Page  59) 


— 53  — 


National  Compulsory  Health  Insurance  Threatens  Again 


The  Forand  Bill  (HR  9467)  was  introduced  by  Representative  Forand  of  Rhode  Island. 
Essentially  it  is  the  National  Compulsory  Health  Insurance  of  the  Wagner-Murray-Dingell 
variety,  only  covering  a smaller  segment  of  the  population.  The  A.F.L.-C.I.O.  assisted  Con- 
gressman Forand  in  framing  his  bill.  It  proposes  that  the  Federal  Government,  through  the 
Social  Security  System,  pay  the  costs  of  hospital,  nursing  home  care  and  surgery  of  persons 
eligible  for  Old  Age  and  Survivors  insurance  benefits.  The  segment  of  the  population  covered 
would  number  about  twelve  to  thirteen  million  persons.  The  costs  would  be  met  by  increased 
Social  Security  Taxes  drawn  from  almost  the  entire  working  population.  If  such  legislation 
were  passed,  it  would  be  a short  step  to  decrease  the  age  limits  to  include  all  persons  on  Social 
Security. 

The  American  Medical  Association  recognizes  the  gravity  of  this  new  threat.  They  are  de- 
veloping a vigorous  campaign  against  the  bill.  Fortunately  the  American  Hospital  Association 
Board  of  Trustees  have  stated  their  opposition  to  the  proposal.  It  is  hoped  that  Secretary  Fol- 
som of  the  Department  of  Health,  Education  and  Welfare  will  recommend  that  the  Administra- 
tion oppose  the  Forand  Bill.  But,  the  forces  for  the  legislation  are  formidable.  Social  Security 
has  intrinsic  political  appeal.  As  usually  stated,  it  seems  an  opportunity  of  getting  something 
for  nothing.  The  backers  of  these  utopian  types  of  social  legislation  have  always  adhered  to 
the  less  than  honest  principle.  “If  you  can’t  convince  them,  let’s  confuse  them.” 

I believe  the  citizens  of  our  state  and  particularly  the  doctors  are  less  likely  to  be  confused 
than  those  who  accept  the  political  dicta  of  such  organizations  as  the  AFL-CIO  and  Social 
Welfare  lobbyists.  But  it  is  not  enough  to  be  opposed.  We  must  state  our  opposition  and  the 
reasons  for  it.  You  will  be  given  that  opportunity  as  the  present  congressional  session  pro- 
gresses, through  our  A.M.A.  and  State  Medical  Association  legislative  committees. 

M.  M.  Morrissey,  M.D. 

Pierre,  S.  Dak. 


— 54  — 


IS  BLUE  SHIELD  A "THIRD  PARTY?" 

“Blue  Shield  Plans  exist  only  to  help  the 
medical  profession  facilitate  the  provision  of 
its  services  to  the  people.  Blue  Shield  is  an 
organization  of  the  profession  itself,  and  not 
a third  party  between  doctor  and  patient.” 

So  declared  the  Blue  Shield  Commission  in 
a recent  policy  statement.  The  Commission 
is  the  elected  board  of  directors  of  the  na- 
tional association,  “Blue  Shield  Medical  Care 
Plans,”  whose  members  are  the  70-odd  med- 
ical society-sponsored,  non-profit  Blue  Shield 
Plans.  A preponderant  majority  of  the  Com- 
missioners are  doctors  of  medicine. 

The  medical  profession,  through  its  own 
instrument.  Blue  Shield,  pioneered  the  great 
uncharted  realm  of  medical  prepayment  at 
a time  when  commercial  insurance  com- 
panies declared  it  was  actuarially  impossible, 
and  when  the  bureaucrats  in  Washington  as- 
serted that  only  big  government  could  do 
the  job. 

What  is  a “third  party  between  doctor  and 
patient”?  In  simplest  terms,  a “third  party” 
must  be  some  person  or  agency  over  whom 
neither  the  first  party  — the  patient  — nor 
the  second  party  — the  doctor  — has  any 
direct  control;  someone  independent  of  both 
doctor  and  patient. 

The  first  requirement  of  a medical  pre- 
payment plan  that  wants  to  call  itself  Blue 
Shield  is  that  it  be  approved  by  the  county 
or  state  society  in  the  area  that  it  serves.  The 
second  requirement  is  that  all  medical 
policies  and  operations  be  under  medical 
control;  and  the  third,  that  it  earn  the  volun- 
tary participation  of  at  least  a majority  of 
the  doctors  in  its  territory. 


Blue  Shield  is  not  a “third  party.”  In  truth. 
Blue  Shield  has  proved  that  doctors  and  pa- 
tients, working  together,  can  solve  the  prob- 
lems of  medical  economics  without  needing 
any  third  party  to  come  between  them. 


THE  MONTH  IN  WASHINGTON 

Russian  advances  in  outer  space  have  trig- 
gered a whole  series  of  debates,  not  the  least 
of  which  is  the  issue  of  the  scope  and  extent 
of  federal  participation  in  higher  education. 
From  it  may  emerge  at  the  very  minimum  a 
scholarship  program  benefiting  pre-medical 
students  and  some  medical  students. 

Here  are  some  of  the  questions  that  Con- 
gress will  have  to  answer  before  it  writes  a 
final  bill  on  federal  aid  to  higher  education: 

1.  Should  a program  be  limited  to  federal 
scholarships  or  should  it  include  grant  money 
for  improving  and  enlarging  colleges  and  uni- 
versities, or  for  loans  to  students? 

2.  If  it  is  limited  to  scholarships,  should 
they  be  non-categorical  in  nature  rather  than 
favoring  specific  disciplines? 

3.  If  non-categorical  and  thus  benefiting  all 
phases  of  higher  education,  how  best  to  jus- 
tify this  approach  in  the  national  interest  and 
national  security? 

4.  Finally,  if  aimed  at  specific  disciplines, 
should  not  Congress  require  some  obligation 
for  service  on  the  part  of  the  recipient? 

Some  of  the  answers  have  been  given  in  the 
administration’s  plan  now  before  Congress. 
As  outlined  by  Secretary  Folsom  of  the  De- 
partment of  Health,  Education  and  Welfare, 


— 55  — 


SOUTH  DAKOTA 


$1  billion  would  be  authorized  over  a four- 
year  period.  The  money  would  go  for  10,000 
scholarships  a year  to  bright  students  unable 
to  finance  their  schooling,  for  National 
Science  Foundation  grants  and  fellowships 
for  post-doctoral  training  and  up  to  $125,000 
for  any  one  school  to  improve  facilities. 

It  has  been  explained  that  this  program 
would  benefit  pre-medical  students  but  that 
since  scholarships  would  be  limited  to  four 
years,  students  would  have  to  find  other 
ways  to  finance  most  of  their  years  in  med- 
ical school.  After  receiving  their  medical 
degrees,  however,  they  would  be  eligible  for 
the  fellowships  from  the  National  Science 
Foundation. 

The  administration  program  favors  the 
non-categorical  approach,  although  prefer- 
ence would  be  given  high  school  students 
with  good  preparation  in  math  and  the 
sciences.  Students  themselves  would  decide 
what  college  course  to  pursue. 

This  program  has  met  mixed  reaction. 
Educators  say  considerably  more  money 
should  be  authorized  — some  asking  for  as 
much  as  four  times  the  proposed  $1  billion. 

The  American  Council  on  Education, 
which  takes  in  nearly  all  accredited  colleges, 
universities  and  junior  colleges,  told  a House 
Education  subcommittee  that  the  10,000 
scholarships  are  “a  minimum  below  which  a 
program  of  effectiveness  would  be  doubtful 

The  council  outlined  for  the  subcommittee 
these  guiding  principles: 

1.  The  student  should  have  complete  free- 
dom to  choose  his  own  program  of  studies 
within  the  requirements  set  by  the  individual 
institution. 

2.  Stipends  up  to  a maximum  amount  set 
generally  for  the  program  should  be  suf- 
ficient to  enable  the  student  to  attend  an 
eligible  college. 

3.  The  student  should  not  be  denied  the 
opportunity  to  attend  any  recognized  college 
or  university  properly  accredited  under  a 
regional  accrediting  association. 

4.  There  should  be  no  discrimination  be- 
cause of  race,  creed,  color  or  sex. 

NOTES: 

First  legislative  activity  of  interest  to  the 
medical  profession  this  year  was  the  House 
Ways  and  Means  Committee’s  month-long 
hearing  on  tax  revision;  testimony  in  favor 


of  the  Jenkins-Keogh  bill  was  presented  late 
in  January. 

* * * 

National  Science  Foundation  is  inviting  col- 
leges and  universities  to  apply  for  financial 
help  in  conducting  in-service  courses  and  in- 
stitutes for  advanced  study  by  high  school 
mathematics  and  science  teachers.  Applica- 
tions must  be  received  by  NSF  before  March 
15. 

* * * 

A new  national  organization  has  been  es- 
tablished to  help  in  finding  a cure  for  ulcera- 
tive colitis.  Encouraged  by  the  National  In- 
stitute of  Arthritis  and  Metabolic  Diseases, 
the  new  foundation  will  use  its  funds  to  sup- 
plement those  awarded  by  the  federal  gov- 
ernment. 

* * * 

After  six  months’  operation  of  the  disability 
payments  program  under  social  security, 
benefits  were  going  to  more  than  131,000  and 
totaled  $10  million  a month.  Within  the  next 
12  months  the  rolls  are  expected  to  increase 
to  about  200,000,  at  an  annual  cost  of  about 
$175  million. 

* * * 

Influential  Rep.  John  Fogarty  (D.,  R.  1.) 
wants  the  House  to  ask  President  Eisenhower 
to  call  a White  House  conference  on  aging, 
at  which  medical  and  all  other  problems  of 
the  older  population  would  be  taken  up.  Mr. 
Fogarty  also  would  attempt  to  interest  states 
in  similar  conferences,  to  be  conducted  prior 
to  the  Washington  meeting. 


SUPPLIMENTARY  LIST 


The  following  is  a list  of  AMEF  contribu- 
tors listed  in  the  January  issue  incorrectly 


K.  P.  Currie,  M.D. 
K.  Zvejnieks,  M.D. 
M.  W.  Larsen,  M.D 
S.  Friefeld,  M.D. 

R.  B.  Henry,  M.D. 
R.  L.  Lillard,  M.D. 


A.  Horthy,  M.D. 

I.  D.  Eirinberg,  M.D. 
E.  T.  Lietzke,  M.D. 

J.  A.  Hohf,  M.D. 

J.  A.  Lowe,  M.D. 

V.  Janavs,  M.D. 


SUPPLIMENTARY  LIST 
CONTRIBUTORS  TO  AMEF 

H.  L.  Ahrlin,  M.D Rapid  City,  S.  Dak. 

P.  M.  Berg,  M.D Billings,  Mont. 

C.  J.  McDonald,  M.D Sioux  Falls,  S.  Dak. 

C.  B.  Mitchell,  M.D Sioux  Falls,  S.  Dak. 

J.  F.  Pokorny,  M.D. Newell,  S.  Dak. 

M.  E.  Sanders,  M.D Redfield,  S.  Dak. 

J.  P.  Villa,  M.D Freeman,  S.  Dak. 


— 56  — 


FEBRUARY  1958 


SIOUX  VALLEY  MEDICAL  SOCIETY 
ANNUAL  MEETING 
February  25,  26,  27,  1958 
SIOUX  FALLS 

TUESDAY  (February  25th) 

Clinic  Day  at 

Sioux  Valley  Hospital  on  Tuesday,  February 

25th.  Interesting  papers  by  physicians  of  the 

Seventh  District. 

The  Following  Sessions  will  be  held  at  the 
Sheraton  Cataract 

WEDNESDAY  (February  26th) 

Robert  Chissom,  M.D.,  Professor  of  Medicine, 
University  of  Nebraska  will  lecture  on: 

1.  Cardiac  Arrythmias 

2.  New  Concepts  in  Treatment  of  Con- 
gestive Heart  Failure 

John  H.  Moore,  M.D.,  Chairman  of  the  De- 
partment of  Obstetrics  and  Gynecology, 
Grand  Forks  Clinic  will  speak  on: 

1.  Obstetric  Hemorrhage 

2.  Some  Common  Problems  in  Gyne- 
cology 

William  H.  Requarth,  M.D.,  Decator,  Illinois 
will  present: 

1.  Modern  Treatment  of  Burns 

2.  Treatment  of  Hand  Injuries 
THURSDAY,  (February  27th) 

J.  A.  Bargen,  M.D.,  Professor  of  Medicine, 
Mayo  Foundation  and  Chairman  of  the  De- 
partment of  Gastroenterology,  Mayo  Clinic 
will  discuss: 

1.  Problems  in  the  Management  of 
Ulcerative  Colitis  and  Associated 
Conditions 

2.  Diagnosis  and  Treatment  of  Diver- 
ticulitis of  the  Large  Intestine. 

Ellsworth  Evans,  Sioux  Falls  attorney,  will 
outline  the  legal  hazards  that  physicians 
may  encounter  in  daily  practice  in  an  in- 
teresting paper. 

John  Christian,  M.D.,  Professor  Pediatrics, 
Stritch  School  of  Medicine,  Loyola  Univer- 
sity, Chicago,  Illinois  will  discuss: 

1.  Rheumatic  Fever  in  Children 

2.  Virus  Diseases  of  Childhood 

John  C.  Trabue,  M.D.,  Associate  Professor  of 
Surgery,  Ohio  State  University  School  of 
Medicine  will  speak  on: 

1.  Common  Surgical  Lesions  of  the 
Skin 

2.  Treatment  of  Maxillo-Facial  In- 
juries 


TUESDAY  EVENING,  (February  25th) 

BIG  STAG  PARTY 

Sheraton-Cataract  Hotel,  Courtesy  of  the 
Seventh  District  Medical  Society. 

Doctor  Walter  Hard,  Dean,  University  of 
South  Dakota  School  of  Medical  Sciences 
will  talk  briefly  on: 

Changing  Trends  in  Medical  Education 
Refreshments  of  all  kinds  on  into  the  night . . 

WEDNESDAY  EVENING 
Sheraton-Cataract  Hotel  — Cocktail  party, 
dinner  and  dancing. 

REGISTRATION 

TUESDAY,  WEDNESDAY  AND  THURS- 
DAY, AT  SHERATON-CATARACT  HOTEL 
Please  get  your  reservations  in  early  as  a 
large  crowd  from  a three  state  area  is  ex- 
pected. 


WHAT  IS  THE  SAFEST  TONSILLECTOMY 
ANESTHESIA?— 

(Continued  from  Page  40) 

14.  Slater,  H.  M.,  and  Stephen,  C.  R.:  Anesthesia 
for  Tonsillectomy  and  Adenoidectomy.  Canad. 
M.  J.  64:22-26  (Jan.)  1951. 

15.  Campbell,  J.  C.,  and  Hunter-Smith,  D.:  Guil- 
lotine Tonsillectomy  and  Curettage  of  Ad- 
enoids Under  Ethyl  Chloride  Anesthesia,  Brit. 
M.  J.  1:1451-1453  (June  18)  1955. 

16.  Jarvis,  J.  R.:  Anesthesia  for  Tonsillectomy 
Made  Easy,  GP  7:61-65  (April)  1953. 

17.  Segal,  B.:  “Open”  Endotracheal  Anesthesia 
for  Tonsillectomy  and  Adenoidectomy  in 
Children,  South  African  M.  J.  23:514-516 
(June  25)  1949. 

18.  Slater,  H.  M.,  and  Stephen,  C.  R.:  Anesthesia 
for  Infants  and  Children:  The  Nonbreathing 
Technic,  A.M.A.  Arch.  Surg.  62:251-259  (Feb.) 
1951. 

19.  Eather,  K.  F.:  The  Common  Hazards  of  Gen- 
eral Anesthesia  for  Tonsillectomy  and  Ad- 
enoidectomy, Northwest  Med.  51:671-673 
(Aug.)  1952. 

20.  Barton,  R.  T.,  and  Roman,  D.  A.:  Endotra- 
cheal Technique  for  Adenotonsillectomy, 
A.M.A.  Arch.  Otolaryng.  61:241-243  (Feb.) 
1955. 

21.  Fateen,  M.:  Endotracheal  Intubation  in  Guil- 
lotine Tonsillectomy,  J.  Roy.  Egyptian  M.  A. 
36:69-76,  1953. 

22.  Hallberg,  O.  E.,  and  Pender,  J.  W.:  Endotra- 
cheal Anesthesia  for  Tonsillectomy  and  Ad- 
enoidectomy in  Children:  Advantages  and 
Disadvantages,  J.  Internet.  Coll.  Surgeons 
23:527-531  (April)  1955. 

23.  Baron,  S.  H.,  and  Kohhnoos,  H.  W.:  Laryngeal 
Sequelae  of  Endotracheal  Anesthesia,  Ann. 
Otol.  Rhin.  & Laryng.  60:767-792  (Sept.)  1951. 

24.  Hamrick,  D.  W.:  Choice  of  Anesthesia  for 
Tonsil  and  Adenoid  Surgery  in  Children, 
A.M.A.  Otolaryng.  62:393-398  (Oct.)  1955. 

25.  Steele,  C.  H.,  and  Anderson,  J.  R.:  Tracheo- 
bronchial Aspiration  Following  Tonsillec- 
tomy with  General  Anesthesia,  Arch.  Oto- 
laryng. 51:699-706  (May)  1950. 

26.  Myerson,  M.  C.:  Bronchoscopic  Observation 
on  the  Cough  Reflex  in  Tonsillectomy  Under 
General  Anesthesia,  Laryngoscope  34:63-68 
(Jan.)  1924. 


— 57  — 


MEDICAL  LIBRARY  BOOKSHELF  < 


A distinguished  researcher,  Dr.  John  Bitt- 
ner, was  the  guest  speaker  at  the  last  meeting 
of  the  Student  American  Medical  Association 
held  at  the  University  on  December  4th. 
According  to  American  Men  of  Science.  Dr. 
Bittner  received  a Ph.D.  in  genetics  from  the 
University  of  Michigan  where  he  later  be- 
came an  assistant  in  cancer  research.  Since 
1942,  he  has  been  the  George  Chase  Christian 
Prof,  of  Cancer  Research  and  Director  of 
Cancer  Biology  of  the  Physiology  Depart- 
ment of  the  University  of  Minnesota  Medical 
School.  In  his  talk.  Dr.  Bittner  stated  that 
the  Cancer  Chair  which  he  holds  is  unique 
because  it  is  the  only  one  of  its  kind  to  be 
supported  from  the  sale  of  mice,  (surplus 
laboratory  experimental  mice).  His  exper- 
ience in  cancer  research  has  been  extensive, 
including  special  cancer  investigator  of  the 
U.  S.  Public  Health  Service  and  research  fel- 
low of  the  National  Cancer  Institute.  In  1947, 
he  was  president  of  the  American  Association 
of  Cancer  Research.  In  1941,  he  received  the 
Alvarenga  prize  award  from  the  College  of 
Physicians  of  Philadelphia,  and  in  1951,  the 
Comfort  Crookshank  award  and  lecture,  Mid- 
dlesex Hospital,  Medical  School  of  London. 
He  has  participated  in  numerous  symposiums 
and  congresses. 

The  title  of  Dr.  Bittner’s  talk  to  the  med- 
ical students,  staff  members,  and  guests  was 
“Development  and  Control  of  Mammary 
Cancer  In  Mice.”  Using  numerous  complex 
charts,  he  explained  the  genetics  and  inbreed- 
ing in  relationship  to  cancer;  hormonal  fac- 
tors of  breast  cancer  in  mice;  statistics  con- 
cerning incidence  of  cancer,  stock  used  as  re- 
cipient hosts,  susceptibility,  survival  time, 
maternal  influence  and  other  data. 


Dr.  Bittner,  alone  and  in  collaboration  with 
others,  has  published  numerous  articles  on  re- 
search cancer  experiments  with  mice.  In  1940, 
an  article  entitled  “Breast  Cancer  in  Mice  as 
Influenced  by  Nursing”  was  published  in  the 
Journal  of  the  National  Cancer  Institute, 
vol.  1;  155,  1940.  It  was  discovered  that  the 
maternal  influence  of  breast  cancer  develop- 
ment in  mice  is  transferred  in  the  milk  to  the 
progency  while  nursing,  and,  also,  that  tumor 
incidence  normally  obtained  in  females  of 
high-tumor  strains  of  mice  may  be  reduced 
as  a result  of  foster  nursing  the  young  of  such 
animals  by  low  tumor-stock  females  before 
they  are  24  hours  old.  Three  influences  in 
the  etiology  of  inherited  breast  cancer  in  mice 
are  (1)  the  milk  influence,  (2)  inherited  sus- 
ceptibility, and  (3)  ovarian  hormal  stimula- 
tion of  the  mammary  gland. 

A recent  article  co-authored  by  Dr.  Bittner 
in  Cancer  Research,  vol.  17:  205,  1957  is  “Con- 
tinuous Growing  Isotransplants  of  a Mam- 
mary Tumor  Associated  with  the  Develop- 
ment of  Immunity  in  Mice.” 

According  to  the  summary,  it  was  con- 
firmed that  mice  with  either  a single  tumor 
transplant  growing  in  the  left  ear  for  thirty 
days  or  with  three  successive  innoculations 
of  the  same  tumor,  each  being  left  at  each 
location  for  only  ten  days,  were  then  resistant 
to  a subcutaneous  innoculation  of  tumor 
made  into  the  groin. 


GIFT  BOOK  TO  MEDICAL  LIBRARY 
William  and  Wilkins  sent  us  recently  a gift 
book  for  reviewing.  This  is  the  7th  edition 
fo  an  English  book  by  George  Edward  Trease, 


— 58  — 


FEBRUARY  1958 


A Textbook  of  Pharmacognosy,  1957.  Because 
this  book  contains  much  material  about  the 
botanical  side  of  pharmacognosy,  Dr.  John  M. 
Winter,  the  head  of  the  Botany  Department 
at  the  University,  agreed  to  make  a few  com- 
ments in  regard  to  it. 

The  author,  in  his  historical  introduction, 
defines  pharmacognosy  as  that  science  which 
deals  with  the  investigation  of  drugs  and 
other  raw  materials  of  vegetable  and  animal 
origin.  The  study  includes  their  history, 
commerce,  cultivation,  collection,  prepara- 
tion for  market  and  storage,  their  chemistry 
and  identification  and  evaluation,  both  in  the 
whole  and  powdered  state.  He  points  out  that 
pharmacognosy  is  taught  in  schools  of  phar- 
macy while  materia  medica  is  the  term  used 
in  medical  schools. 

The  book  as  a whole,  in  Dr.  Winter’s 
opinion,  is  an  excellent  treatment  which  is  of 
interest  to  the  non-professional  as  well  as 
those  engaged  in  pharmacology,  specifically 
and  medicine  in  general. 

The  following  are  his  comments: 

Part  I,  General  Principles,  Chapter  4,  in 
which  enzymes  and  the  cultivation  of  med- 
icinal plants  are  discussed,  is  too  short  to  be 
of  much  practical  value.  Bevity  is  also  the 
criticism  of  Chapter  8 of  Part  II,  Drugs  of 
Vegetable  Origin  which  attempts  to  cover 
most  of  the  terms  in  plant  taxonomy  and 
anatomy  applicable  to  the  study  of  parts  used 
in  preparation  of  drugs.  The  good  references 
at  the  end  of  the  chapter  would  be  helpful 
for  supplementary  information.  Chapter  12 
on  antibiotics  (four  pages  plus  reference  list) 
is  mighty  fast  coverage  of  the  increasingly 
important  source  of  widely  used  drugs. 

Chapters  14-18  covering  the  plant  sources 
of  drug  products  are  excellent.  It  is 
interesting  to  know  that  the  U.  S.  imports 
annually  ten  million  pounds  of  mustard  seed, 
while  the  Midwestern  states  have  areas  where 
it  takes  over  fields  and  grows  luxuriantly  as 
a weed.  (Agricultural  chemists  searching  for 
new  agricultural  products  take  note.  Also 
ephedra,  a source  of  alkaloid  ephedrine  has 
been  grown  with  satisfactory  results  in  South 
Dakota).  In  these  chapters,  the  sequence  is  a 
taxonomic  one  proceeding  from  the  algae  to 
the  gymnospermae  and  through  the  flowering 


plants  to  the  composites  with  each  discussed 
briefly  under  general  topic  headings  of 
source,  history,  collection,  characters,  con- 
stituents, and  uses. 

Part  III  is  a curious  compendium  covering 
such  items  as  chalk,  leeches,  cochineal  cod 
liver  and  sperm  oil  and  others.  Part  IV  in- 
cludes good  though  condensed  discussions  of 
the  constituents  of  drugs,  method  of  extrac- 
tion, analysis  of  flourescenses,  chromato- 
graphy and  tracer  techniques.  Part  V covers 
the  uses  of  the  microscope  in  the  identifica- 
tion of  fibre  cell  parts,  crystals,  etc. 

Some  parts  of  this  book  would  be  of  more 
interest  to  the  drug  products,  cosmetic  or 
spice  business  than  to  students  of  pharma- 
cognosy. It  would  be  better  if  the  lists  were 
cut  down  to  those  drug  sources  actually 
needed  at  the  present  time  in  medical  prac- 
tice. 


OBSTETRIC  CASE  STUDY— 

(Continued  from  Page  53) 

ripened  the  cervix  some.  The  bloody  show 
proceeding  the  final  admission  was  the  only 
sign  of  labor  as  there  was  no  dilitation,  efface- 
ment,  nor  descent.  The  quality  of  uterine 
contractions  was  mild  and  irregular.  Of 
course.  Cesarian  Section  was  considered  al- 
though not  seriously  as  clinically  this  gravida 
should  have  been  able  to  deliver  from  below 
babies  of  this  size  if  delivery  was  not  too  long 
delayed.  The  patient  did  not  go  into  spon- 
taneous labor  after  three  days  of  show  and 
desultory  contractions,  so  that  vigorous  con- 
trolled in  duction  was  deemed  advisable.  Un- 
fortunately the  patient  responded  to  the  in- 
duction with  the  delayed  type  of  labor  adding 
to  her  discomfort  and  prolonging  further  the 
situation.  It  is  of  importance  to  note  that 
this  patient  was  confidently  cooperative  dur- 
ing the  entire  preceedure  and  at  this  writing 
is  eight  months  pregnant  with  a single  preg- 
nancy and  doing  well.  We  feel  that  this 
brings  out  an  evidence  of  cooperation  be- 
tween our  specialist  colleagues  and  the 
country  doctor  to  produce  a safe  delivery  in  a 
small  32  bed  county  hospital  in  an  isolated 
area. 


— 59  — 


New  rapid-acting  ACHROMYCIN  V Capsules  offer  more 
patients  consistently  high  blood  levels— at  no  sacrifice 
to  the  broad  anti-infective  spectrum  of  ACHROMYCIN 
Tetracycline,  its  low  Incidence  of  side  effects,  or  its  dosage 
and  indications. 

The  pure,  unaltered  crystalline  tetracycline  HCI  molecule 


Tetracyollne  HCI  Buffered  with  CItrlo  Acid 


prompt  and  high  blood  levels,  faster  broad-spectrum  action 
...rapidly  decisive  control  of  infections.  New  ACHROMYCIN 
V Capsules  do  not  contain  sodium. 

REMEMBER  THE  V WHEN  SPECIFYING  ACHROMYCIN  V 


CAPSULES'  (blue-yellow)  250  mg.  tetracycline  HCI  (buffered  with  citric  acid,  250  mg.);  100  mg.  tetracycline  HCI 
(buffered  with  citric  acid,  100  mg.).  ACHROIVI YCIN  V DOSAGE : Recommended  basic  oral  dosage  is  6-7  mg. 
per  lb.  body  weight  per  day.  In  acute,  severe  infections  often  encountered  in  infants  and  children,  the  dose  should  be  12 
mg.  per  lb.  body  weight  per  day.  Dosage  in  the  average  adult  should  be  1 Gm.  divided  into  four  250  mg.  doses. 


uLEDERUE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY.  PEARL  RIVER.  NEW  YORK 


SOUTH  DAKOTA 


MINUTES  OF  THE 
MEDICAL  SCHOOL  AFFAIRS 
COMMITTEE 

Marvin  Hughitt  Hotel,  Huron,  S.  D. 
January  18.  1958 

Meeting  called  to  order  by  Dr.  McVay. 

The  following  were  present:  Drs.  McVay, 
Brown,  Saxton,  Gillis,  Jahraus,  Price,  Hard, 
and  guest  Stransky. 

The  minutes  of  the  last  meeting  were  read. 
Dr.  Hard  made  one  correction  Subject  6 
should  have  been  1955  instead  of  1957.  Read 
and  approved  as  amended. 

Dr.  Hard  gave  the  following  resume  of 
Medical  Association  activities  at  the  Univer- 
sity of  South  Dakota  Medical  School. 

1.  State  Medical  Association’s  contributions 
to: 

a.  Medical  Student  Scholarships  2 at 

$100.00. 

b.  $50.00  to  partially  defray  travel  ex- 
penses of  delegate  to  SAMA  annual 
meeting. 

c.  Science  Fair. 

Dr.  Saxton  moved  that  the  Committee 
recommend  to  the  Council  of  the  S.  D.  S. 
Medical  Association  the  allocation  of  funds 
for  two  medical  student  scholarships  in  the 
amount  of  $100.00  each,  and  also  $50.00  to 
help  defray  the  cost  of  a delegate  to  the 
Student  AMA  annual  meeting,  and  also 
contribute  to  the  Science  Fair  as  done  in 
the  past.  Seconded  by  Dr.  Brown.  Motion 
carried. 

2.  A.M.E.F.  Contributions  for  Year. 

Dr.  Jahaus  moved  that  the  Medical  School 
Affairs  Committee  express  its  appreciation 
to  the  AMEF  Committee  of  the  S.D.S. 
Medical  Association  for  their  efforts  to  in- 
crease AMEF  contributions  in  1957.  Sec- 
onded by  Dr.  Saxton.  Motion  carried. 

Dr.  Hard  was  instructed  by  the  Committee 
to  publicize  the  AMEF  contributions. 

3.  Creation  of  Poison  Registry  Center. 

Dr.  Price  moved  that  the  Medical  School 
Affairs  Committee  recommend  to  the  Coun- 
cil of  the  S.D.S.  Medical  Association  that 
a Poison  Registry  Center  be  established  at 
the  University  of  South  Dakota,  and  that 
wide  spread  publicity  be  given  to  South 
Dakota  doctors  on  this  matter.  Seconded 
by  Dr.  Gillis.  Motion  carried. 

4.  Blood  Bank  Workshop. 

Dr.  Price  moved  that  the  Medical  School 


Affairs  Committee  recommend  to  the  Coun- 
cil of  the  S.D.S.  Medical  Association  the 
continuation  of  refresher  courses,  at  the 
University  of  South  Dakota  with  the  view 
to  improve  the  level  of  laboratory  work 
done  in  the  hospital  and  doctor  offices  in 
the  State  of  South  Dakota.  Seconded  by 
Dr.  Jahraus.  Motion  carried. 

Dr.  Hard  gave  the  Committee  information 
on  the  following: 

5.  Medical  School  Annual  Dinner-Dance, 
March  29. 

Dr.  Fred  Coller — “Evolution  of  Surgery” 
Hare  Memorial  Scholarship  Fund. 

6.  The  transferring  of  Medical  Students. 

7.  Tuition  Increase  for  out-of-state  students 
to  $600.00  or  an  increase  of  $50.00  a year. 
In-state  as  is  or  $320.00  a year. 

8.  Building  Addition  Planned. 

9.  Problems  of  Medical  School  Admissions. 
Dr.  Jahraus  moved  that  the  Medical  School 
Affairs  Committee  recommend  to  the  Coun- 
cil of  the  S.D.S.  Medical  Association  that 
the  problem  of  Medical  School  Admissions 
be  considered  and  that  each  District  Med- 
ical Society  in  the  State  make  an  effort  to 
participate  in  AMEF  Week  this  year,  which 
is  April.  Seconded  by  Dr.  Price.  Motion 
carried. 

The  meeting  adjourned  on  motion  at  10:30 

P.M. 


C.  L.  BURY,  M.D. 

1882-1958 

Funeral  services  for  Dr.  C.  L.  Bury  of 
Geddes  were  held  at  the  Community  Meth- 
odist Church  in  Geddes  January  11th.  Burial 
was  in  the  Rosehill  Cemetery  in  Parker. 

Dr.  Bury  practiced  at  Geddes  33  years  be- 
fore being  forced  to  retire  as  a result  of  poor 
health.  Prior  to  that  he  practiced  at  Parker 
for  a number  of  years. 

He  is  survived  by  his  widow,  one  son,  one 
daughter,  and  two  grandchildren. 


NEWS  NOTES 

T.  J.  Billion,  M.D.  was  elected  president  of 
the  McKennan  Hospital  Staff  in  Sioux  Falls 
for  the  year  1958. 


-60  — 


A.C.S.  MEETING 
IN  DES  MOINES 

All  members  of  the  med- 
ical profession  are  invited  to 
attend  a three-day  Sectional 
Meeting  of  the  American  Col- 
lege of  Surgeons  in  Des 
Moines,  Iowa,  March  27 
through  29,  at  the  Hotel  Fort 
Des  Moines. 

Dr.  Ralph  A.  Dorner,  Des 
Moines,  is  Chairman  of  the 
Advisory  Committee  on  Lo- 
cal Arrangements. 

Topics  will  include  emer- 
gency care  of  multiple  in- 
juries, surgery  for  congenital 
lesions,  cardiac  arrest,  ' can- 
cer, Jaundiced  patient,  ovar- 
ian tumors,  fluids  and  elec- 
trolytes. Medical  motion  pic- 
tures will  also  be  shown 
daily,  with  an  especially 
selected  program  scheduled 
for  Thursday  evening. 


"EDEMA''  COURSE 
AT  COLORADO 

“Edema-  Its  Pathogensis 
and  Management  is  the  sub- 
ject of  a postgraduate  course 
to  be  held  at  the  U of  Colo- 
rado Medical  Center  in  Den- 
ver, March  13th  through  15th. 

Registration  and  tuition 
fee  of  $25.00  should  accom- 


pany the  application  which 
should  be  forwarded  to  the 
Medical  Center  at  4200  East 
Ninth  Avenue,  Denver  20, 
Colorado. 


NATUROPATH 
GETS  INJUNCTION 

A Rapid  City  woman  op- 
erating “Naturopathic”  of- 
fices was  prohibited  from 
using  the  title  of  “doctor”  in 
connection  with  her  work. 

The  action  against  Anna 
Eicens,  429  Quincy,  was 
brought  by  Dr.  Gregg  M. 
Evans,  Yankton,  in  his  of- 
ficial capacity  as  secretary- 
treasurer  of  the  South  Da- 
kota Basic  Science  Board. 
The  action  asked  that  Mrs. 
Eicens  be  prohibited  from 
representing  herself  as  a 
doctor  of  human  disorders. 

Evans  charged  that  Mrs. 
Eicens,  who  operates  the 
Naturopathic  Health  Clinic 
here,  examined  a man  patient 
on  July  31,  and  diagnosed 
and  treated  him  for  an  ail- 
ment, representing  herself  as 
a qualified  physician.  She 
was  paid  for  the  services 
according  to  the  complaint. 

Judge  Tom  Parker  in  Cir- 
cuit Court  decided  that  alle- 


gations against  Mrs.  Eicens 
were  correct  as  presented, 
and  she  was  enjoined  from 
“using  the  title  doctor  or  any 
contraction  or  variation  of 
the  title,  from  using  the  name 
clinic  in  such  a manner  as  to 
hold  out  to  the  public  that 
such  a place  is  for  diagnosis 
and  treatment  of  human  ills,” 
and  is  also  prevented  from 
advertising  herself  as  a doc- 
tor. 

In  addition,  she  is  en- 
joined from  “holding  herself 
out  in  any  manner  as  quali- 
fied to  engage  in  the  diag- 
nosis or  treatment  of  any 
human  ill.” 

The  complaint  stated  that 
Mrs.  Eicens  has  been  operat- 
ing the  “health  clinic”  and 
representing  herself  as  a doc- 
tor for  more  than  two  years. 
Action  was  filed  against  the 
woman  on  Sept.  3,  charging 
she  is  “not  a holder  of  any 
legal  and  unrevoked  license 
or  certificate  authorizing  her 
to  practice  any  healing  art 
whatsoever.” 

Evans,  appearing  for  the 
state  basic  science  board,  was 
represented  by  Attorney 
John  H.  Zimmer,  Parker,  and 
Mrs.  Eicens  retained  Jack 
Hunt  as  her  attorney. 


SOUTH  DAKOTA 


Pictured  above  are  the  Medical  Students’  wives  at  the  University  of 
South  Dakota  in  their  campaign,  “Toys  For  Tots”  at  Christmas  time. 
Left  to  right:  Mrs.  John  Smiley,  Mrs.  Myron  Fahrenwold,  Mrs.  Wil- 
liam Pierson, Mrs.  Everett  Koenig,  Mrs.  Chester  Anderson,  Mrs.  James 
Monfore,  Mrs.  Patrick  Flynn,  Mrs.  Lowell  Sorensen,  Mrs.  Thomas 
Bairnson. 


P.G.  COURSE  SET 
FOR  CREIGHTON 

Creighton  University 
School  of  Medicine  will  pre- 
sent a Postgraduate  Con- 
ference at  the  Creighton 
Memorial-St.  Joseph’s  Hos- 
pital and  the  School  of  Med- 
icine on  April  8,  9 and  10, 
1958.  The  first  day  will  be 
devoted  to  Practical  Clinical 
Hematology  with  Dr.  Wil- 
liam Harrington,  Associate 
Professor  of  Medicine  and 
Director  of  the  Department 
of  Hematology,  Washington 
University  School  of  Med- 
icine, St.  Louis,  as  guest 
speaker.  The  second  day 
will  be  devoted  to  Rehabili- 
tation Procedures  with  Dr. 
Frederick  J.  Kottke,  Profes- 
sor and  Chairman  of  the  De- 
partment of  Physical  Med- 
icine and  Rehabilitation,  Uni- 
versity of  Minnesota  School 
of  Medicine  as  guest  speaker. 


INTERNISTS  MEET 
INTERNATIONALLY 

The  Fifth  International 
Congress  of  Internal  Med- 
icine will  be  held  in  Phila- 
delphia April  23-26,  1958. 
World  reknowned  medical 
authorities  will  appear  on  the 
program. 

This  is  the  first  meeting  of 
the  society  to  be  held  in  the 
United  States.  It  was  ar- 
ranged on  invitation  of  the 
American  College  of  Phys- 
icians and  is  intended  to  en- 
courage greater  participation 
of  the  American  physicians 
in  the  International  Society 
and  to  give  foreign  members 
an  opportunity  to  learn  more 
about  American  develop- 
ments in  the  Medical 
sciences. 

Information  and  applica- 
tions can  be  secured  by  writ- 
ing the  Secretary-General, 
4200  Pine  Street,  Philadel- 
phia 4,  Pa. 


NEWS  NOTES 
Robert  S.  Westaby.  Jr., 
M.D.,  formerly  at  Martin, 
S.  D.  and  more  recently  of 
Fort  Worth,  Texas,  has  en- 
tered practice  at  Rapid  City 
with  Dr.  John  Erickson. 
Their  offices  are  located  in 
the  old  General  Hospital 
Building. 

* * * 

The  Vermillion  doctors  en- 
tertained members  of  the 
staff  of  the  Dakota  Hospital 
and  Nursing  Home  at  a 
Christmas  party  December 
18th. 


The  grand  opening  of  the 
Milbank  Clinic  was  held  De- 
cember 29th.  Dr.  D.  A. 
Gregory,  Dr.  E.  A.  Johnson, 
and  Dr.  V.  Janavs  form  the 
staff. 

* * * 

Dr.  Romans  Auskaps,  Lake 
Norden,  has  been  named 
chief  of  staff  of  Memorial 
Hospital  in  Watertown  for 
1958. 

* * * 

Dr.  J.  M.  Byrd,  associated 
with  Dr.  F.  U.  Sebring  at 
Martin  for  the  past  eight 
months  has  moved  to  Silver 
City,  New  Mexico. 


MED.  ASSISTANTS 
MEET 

The  Sioux  Falls  Chapter  of 
the  American  Association  of 
Medical  Assistants  held  their 
monthly  meeting  in  the 
Chamber  of  Commerce 
Rooms,  Monday  January  6th. 
After  the  business  meeting 
and  the  discussion  of  the 
meeting  to  be  held  in  Huron 
May  24th,  a book  review  by 
Mrs.  James  Bezpaletz  was 
given.  The  next  meeting  of 
the  Assistant’s  will  be  held 
in  the  Chamber  of  Commerce 
Rooms,  February  3 at  8:30. 


— 62  — 


iCEUTl 

SECTION 


HAROLD  S.  BAILEY.  PH.D. 
EDITOR 

Division  of  Pharmacy 
South  Dakota  State  College 
Brookings.  South  Dakota 


— 63  — 


ACEUTICAL 


m^ 


ANIMAL  HEALTH  PHARMACY* 
Part  VI 

Kenneth  Redman,  Ph.D.** 
Stomach  Poisons  Used  in  Insecticides 


Stomach  poisons  are  commonly  used 
against  chewing  insects,  but  are  sometimes 
used  against  other  insects  under  special  con- 
ditions. These  insecticides  are  often  applied 
in  the  form  of  dusts  or  sprays  to  plants  or 
other  insect  hosts  to  protect  them.  Sometimes 
stomach  poisons  are  mixed  with  attractive 
insect  food  and  set  as  bait  for  grasshoppers, 
flies,  mosquito  larvae,  etc.  Sometimes  these 
insecticides  are  placed  where  insects  will  get 
them  on  their  feet  or  other  parts  of  their 
bodies.  If  the  insecticide  is  irritating,  es- 
pecially, the  insect  may  get  a sufficient 
amount  in  the  stomach  to  kill  it  when  trying 
to  remove  the  insecticide  from  its  append- 
ages. Lastly,  some  stomach  poisons  may  be 
placed  in  the  soil  to  be  absorbed  by  plants  in 
sufficient  amount  to  make  the  plants  insec- 
ticidal when  eaten  by  insects. 

Some  of  the  desirable  characteristics  of 
stomach  poisons  include  rapid  action,  avail- 
ability, relatively  low  in  cost,  proper  stability, 
relatively  nontoxic  to  the  host,  proper  fine- 
ness, and  any  residue  left  on  food  products, 
at  least,  should  not  be  harmful  to  man  or 
domestic  animals.  Since  few  insecticides 
meet  this  latter  qualification,  there  are  state 

*The  sixth  of  a series  of  articles  concerning  the 
role  of  the  pharmacist  in  animal  and  plant 
health. 


and  federal  laws  regulating  the  maximum 
(safe)  amount  of  insecticidal  residues  on 
foods. 

Arsenicals  as  Stomach  Poison  Insecticides 
Although  metallic  arsenic  is  not  generally 
considered  to  be  a poison,  all  of  its  compounds 
are  so  regarded.  Since  the  common  valences 
of  arsenic  (As)  are  three  and  five,  it  forms  two 
series  of  compounds,  the  arsenites  and  arsen- 
ates. The  arsenites  are  generally  less  stable 
and  more  soluble  in  water  than  the  arsenates. 
Since  the  effectiveness  of  the  arsenicals  as 
protoplasmic  poisons  is  proportional  to  the 
arsenic  content  and  to  the  amount  of  water 
soluble  arsenic,  the  arsenites  are  better  for 
poison  baits,  while  the  arsenates  are  better 
adapted  to  application  on  plant  hosts,  prim- 
arily. The  federal  and  the  uniform  state  pes- 
ticide acts  require  that  economic  poisons  con- 
taining arsenic  must  have  a statement  on  the 
label  of  containers  indicating  the  percentage 
of  total  arsenic  and  water  soluble  arsenic 
expressed  as  As,  respectively.  From  the  fore- 
going discussion,  it  appears  that  the  ideal 
arsenical  insecticide  would  be  one  with  a 
high  arsenic  content,  none  of  which  is  soluble 
in  water  but  all  of  which  is  soluble  in  the 
gastric  juices  of  insects.  It  would  not  leave 
any  residue  dangerous  to  man  or  domestic 
animals.  It  may  be  discerned  from  the  dis- 
cussion of  the  individual  arsenical  insecticides 
that  follows  that  the  ideal  one  does  not  exist. 
However,  arsenical  insecticides  are  the  most 


**  Professor  and  Head  of  the  Department  of  Phar- 
macognosy, Division  of  Pharmacy,  South  Dakota 
State  College. 


— 64  — 


FEBRUARY  1958 


extensively  used  inorganic  insecticides.  Or- 
ganic arsenicals  have  not  proved  to  be  satis- 
factory insecticides. 

Lead  arsenate  exists  in  several  chemical 
forms,  two  of  which,  PbHAs04  (Acid)  and  Pb4- 
(Pb0H)(AsO4)3  (basic)  are  extensively  used  as 
insecticides.  In  fact,  most  commercial  lead 
arsenate  insecticides  are  mixtures  of  the  two. 
Both  forms  are  insoluble  in  water  and  should 
contain  very  little  of  the  arsenic  oxides  which 
are  water  soluble.  Since  the  basic  lead  ar- 
senate is  more  stable,  it  may  be  indicated  in 
high  humidity  atmospheres  because  of  less 
danger  of  damage  to  foliage  under  this  con- 
dition, but  it  usually  is  not  so  toxic  to  insects. 
It  has  been  claimed  that  acid  lead  arsenate 
is  the  most  extensively  used  stomach  poison. 
It  contains  about  20%  As  equivalent.  Some 
uses  include  control  of  chewing  insects  on 
fruits,  flowers,  trees,  potatoes  and  tomatoes 
with  a high  degree  of  safety  to  the  foliage. 
Lead  arsenate  may  be  used  as  a dust,  diluted 
with  2-20  parts  with  a carrier,  or  spray  (2  to 
3 level  teaspoonfuls/gallon  of  H2O)  and  agi- 
tated while  being  applied.  It  is  sometimes 
used  to  treat  soil  for  Japanese  beetle  larvae 
and  others.  One  method  is  to  apply  a uniform 
coating  to  the  soil  and  then  work  it  in  to  a 
depth  of  4 inches. 

Calcium  arsenate  appears  commercially  as 
an  insecticide  in  the  form  of  a mixture  of 
several  calcium  arsenates  with  an  excess  of 
lime.  It  is  quite  fluffy  and  is  colored  pink  to 
prevent  it  from  being  mistaken  for  flour. 
Most  commercial  insecticides  contain  about 
30  percent  As  equivalent.  Water  soluble  As 
increases  with  age  so  that  the  product  should 
be  used  the  same  year  it  is  made.  Calcium 
arsenate  is  more  toxic  to  insects  and  plants 
than  lead  arsenate.  It  is  used  extensively  on 
cotton  plants  against  the  boll  weevil  and  on 
other  resistant  plants,  such  as  potatoes.  It  is 
incompatible  with  a number  of  other  sprays 
and  some  dusts.  It  is  compatible  with  lime- 
sulfur.  It  is  cheaper  to  use  than  lead  arsenate. 
A calcium  arsenite-calcium  arsenate  mixture 
is  sometimes  sold  under  the  name  of  Lon- 
don purple  for  certain  cotton  and  potato  in- 
sects. 

Paris  green,  a copper-aceto-arsenite  (3Cu- 
(As02)2Cu(C2H302)2  has  been  used  for  many 
years  as  an  insecticide,  especially  for  the  con- 
trol of  Colorado  potato  beetles.  The  Cu  makes 
it  relatively  expensive  without  sufficient 


compensation  in  efficiency  as  an  insecticide, 
so  that  there  isn’t  a really  plausible  reason 
for  using  it.  Where  small  amounts  are  to  be 
used,  of  course,  the  increased  cost  would  be 
insignificant,  and  this  may  account  for  the 
still  considerable  use  in  the  United  States. 
The  usual  strength  spray  contains  IV2  level 
teaspoonfuls  of  Paris  green  and  3 level  tea- 
spoonfuls of  hydrated  lime  to  1 gallon  of 
water. 

Sodium  arsenite  may  vary  in  formula  from 
NaAs02  to  NasAsOs,  depending  on  the  manufac- 
turer of  the  insecticide.  Since  all  sodium  salts 
are  soluble  in  water,  the  sodium  arsenites  are 
only  suitable  to  be  used  in  baits  for  grass- 
hoppers, roaches,  ants,  etc.,  and  in  stock  dips. 
Because  of  their  toxicity  to  plants,  these  ar- 
senites are  sometimes  used  as  weedicides.  The 
As  equivalent  is  about  50  per  cent. 

Arsenic  Trioxide,  AS2O3,  is  the  anhydride  of 
arsenious  acid,  H2ASO4,  which  is  formed  by 
dissolving  arsenic  trioxide  in  water.  The  As 
equivalent  is  about  75  per  cent.  Since  the 
compound  is  soluble  in  water,  it  is  only  suit- 
able for  poison  baits.  Since  it  is  obtained  from 
the  flue  dust  from  copper  smelters,  it  is  one 
of  the  cheapest  of  the  arsenicals.  The  exper- 
ience with  arsenic  trioxide  in  the  last  major 
grasshopper  outbreak  in  the  Great  Plains 
area  of  the  United  States  in  the  1930’s  was 
that  government  agencies  supplied  the  poison 
and  private  dealers  that  ordered  a stock  of 
the  insecticide  for  the  outbreak  still  have  it. 

Fluorine  Compounds  as  Slomach  Poison 

Insecticides 

The  fluorine  compounds  are  comparable  to 
the  arsenicals  in  a number  of  ways.  Those 
that  are  soluble  in  water  are  somewhat  dan- 
gerous to  use  on  foliage  because  they  are 
likely  to  “burn”  it  and  hence  their  uses  are 
largely  restricted,  but  not  as  much  so  as  the 
water  soluble  arsenicals.  The  fluorine  com- 
pounds are  cheaper  to  use  than  the  arsenicals, 
but  are  harder  to  get  in  as  fine  a form.  They 
are  not  generally  regarded  to  be  as  toxic  to 
warm  blooded  animals  as  the  arsenicals.  Some 
of  the  fluorine  compounds  were  introduced 
as  insecticides  to  overcome  the  residue  regu- 
lations of  arsenicals,  but  there  are  now  sim- 
ilar regulations  for  them.  The  soluble  fluor- 
ine compounds  hydrolize  in  water  and  are  in- 
compatible with  calcium  ions,  forming  the 
inert  calcium  fluoride. 

Sodium  fluoaluminate,  also  known  as  cryo- 


— 65 


SOUTH  DAKOTA 


lite,  NasAlFe,  occurs  naturally  (ice-stone)  or 
is  produced  synthetically.  For  most  insecti- 
cidal purposes  the  source  is  not  important, 
however,  provided  that  the  natural  product 
is  not  too  heavy  a powder.  A considerable 
amount  has  been  used  in  the  Pacific  North- 
west since  1925  for  the  control  of  the  codling 
moth.  A spray  containing  3-4  lbs.  of  sodium 
fluoaluminate,  1 pint  of  fish  oil  or  % gallon 
of  emulsified  petroleum  oil  per  100  gallons  of 
spray  has  been  used.  Dusts  of  40-70  per  cent 
sodium  fluoaluminate  in  an  inert  diluent  have 
been  effective  against  caterpillars  on  toma- 
toes, the  potato  tuber  moth,  the  corn  ear- 
worm  and  the  tomato  hornworm.  The  usual 
incompatibilities  for  fluorine  compounds,  ie., 
calcium  compounds,  especially,  apply  to 
cryolite. 

Sodium  flouride,  NaF,  a white  powder,  is 
poisonous  to  all  warm-blooded  animals.  It 
is  required  by  law  to  be  colored  blue  to  pre- 
vent it  from  being  mistaken  for  flour,  a for- 
mer cause  of  deaths  to  humans.  Sodium 
fluoride  is  soluble  in  water  (1  part  in  25 
parts)  and  hence  is  indicated  in  poison  baits 
but  not  for  application  to  plants.  Although 
mainly  a stomach  poison,  sodium  fluoride 
acts  as  a contact  insecticide  to  a certain  ex- 
tent, especially  with  roaches.  Recently  it  has 
been  used  against  roaches  resistant  to  Chlor- 
dane  or  DDT.  It  is  used  quite  extensively  for 
chicken  lice  and  lice  on  other  domestic  an- 
imals, usually  in  the  form  of  dust,  undiluted 
for  chicken  lice  but  from  10-95  per  cent  so- 
dium fluoride  for  other  lice.  A “pinch”  is  ap- 
plied around  the  vent  of  fowls.  Pyrethrum 
or  pyrethrins  are  sometimes  added  to  sodium 
fluoride  dusts  for  synergistic  action.  It  is 
sometimes  fed  to  swine  as  a 1 per  cent  dry 
feed  mixture  for  large  round  worms.  The 
swine  are  allowed  to  eat  all  they  want  of  this 
mixture,  but  nothing  else  for  24  hours.  The 
treatment  is  claimed  to  be  about  95  per  cent 
effective.  Detailed  directions  should  be  fol- 
lowed. 

Sodium  fluosilicate,  Na2SiF6,  has  a solubil- 
ity in  water  low  enough  to  permit  a limited 
use  on  plants  as  a spray  or  dust,  especially 
under  semi-arid  conditions.  It  is  used  against 
some  defoliating  insects  on  cotton,  tomatoes 
and  tobacco,  and  against  the  Mexican  bean 
beetle.  It  has  been  a common  ingredient  in 
grasshopper  baits.  The  strength  of  sprays  are 
about  the  same  as  for  sodium  fluoaluminate. 


while  a dust  of  1 part  sodium  fluosilicate  to 
3 parts  sulfur  may  be  used  with  only  a mod- 
erate possibility  of  danger  to  plants,  es- 
pecially if  the  foliage  is  dry.  Again,  this  com- 
pound should  not  be  used  with  calcium 
products.  Certain  moth  proofing  preparations 
containing  sodium  fluosilicate  have  been  used 
for  years. 

Barium  fluosilicate,  BaSiFo,  is  the  least 
soluble  of  the  commonly  used  fluosilicates 
and  is,  therefore,  suitable  as  an  application 
to  plants.  Solutions  are  quite  toxic  to  humans 
either  externally  or  internally.  Dusts  diluted 
with  inert  dilulents  to  contain  30  to  40  per 
cent  fluorine,  or  sprays  (4  lbs.  to  100  gallons 
of  water)  have  been  used  to  some  extent 
against  Mexican  bean  beetles,  flea  beetles, 
blister  beetles,  etc.  Cryolite  (8  per  cent)  is 
added  to  sprays  to  be  used  in  metallic 
sprayers  to  prevent  corrosion.  Calcium  com- 
pounds and  sulfates  are  incompatible. 

Other  Compounds  Used  as  Stomach  Poison 

Insecticides 

Mild  mercurous  chloride  (calomel)  HgCl, 
insoluble  in  water,  and  corrosive  mercuric 
chloride  (corrosive  sublimate),  HgCl,  water 
soluble,  are  used  against  earthworms,  cab- 
bage and  onion  maggots,  and  fungus  gnats. 
Mercuric  chloride  is  also  used  to  treat  dor- 
mant gladiolus  corms.  A common  strength 
mercuric  chloride  solution  is  1-1000,  prepared 
by  dissolving  7.5  grains  in  1 pint  of  water. 
Mercuric  chloride  is  also  used  as  a fungicide 
and  bactericide. 

Borax  (Na2B407)  and  boric  acid  (H3BO3)  have 
been  used  in  powders  for  roaches.  Four  to 
12  per  cent  solutions  of  borax  have  been  used 
against  green  and  blue  molds  of  citrus  fruits 
and  against  housefly  maggots  in  manure  piles. 
Flies  have  not  become  resistant  to  borax  as 
they  have  the  newer  insecticides  in  some  in- 
stances. It  also  has  been  used  to  prevent  the 
growth  of  mosquito  larvae  in  water  limited 
to  laundry  use.  Boric  acid  has  been  used  to 
control  fleece  worms,  but  the  newer  syn- 
thetics equal  or  exceed  it  in  toxicity. 

Antimony  potassium  tartrate  (K(Sb0)C4H4- 
06.y2H20),  also  known  as  tarter  emetic,  soluble 
in  water,  is  sometimes  used  in  ant  baits  in 
the  proportion  of  1 part  to  20  parts  of  honey  or 
grease,  depending  on  whether  sweet  eating  or 
fat  eating  ants  are  to  be  poisoned.  It  has  been 

(Continued  on  Page  70) 


— 66  — 


PRECEPTORSHIP— YOUR 
RESPONSIBILITY* 
by 

Albert  Edlin** 
Richmond,  Virginia 


Before  any  pharmacist  can  face  the  respon- 
sibility of  being  a preceptor,  he  must  be  sure 
that  he  first  understands  the  meaning  of  the 
term  and  realizes  its  full  significance.  Far  too 
many  pharmacists  consider  the  terms  pre- 
ceptor and  employer  synonymous.  This  is 
totally  incorrect  since  one  may  be  either  an 
employer  or  a preceptor  without  necessarily 
being  both.  Let  us  see  how  Webster  defines 
this  term.  A preceptor  is  “one  who  gives 
precepts.”  Precepts  are  then  defined  as; 

Any  commandment,  instruction  or  order 
intended  as  a rule  of  action  or  conduct; 
especially,  a practical  rule  guiding  be- 
havior, technique,  etc. 

With  this  precise  definition  in  mind,  how 
many  pharmacists  can  measure  up  to  the 
standards  of  their  professional  status  and  in- 
tegrity impose  upon  them? 

Origin  of  System 

The  system  of  preceptorship  goes  back 
into  the  dim  past  when  all  teaching  was  done 
by  the  master  for  his  apprentice.  In  those 
days  the  master  was  revered  by  those  who 

*Reprinted  by  permission  from  the  Ohio  Phar- 
macist 5,  No.  9,  p.  15,  Sept.,  1956.  The  views 
presented  in  this  paper  are  the  writers  and  are 
not  to  be  construed  as  an  official  statement  of 
the  South  Dakota  State  Pharmaceutical  Associa- 
tion nor  of  the  Division  of  Pharmacy,  South  Da- 
kota State  College. 

**At  the  time  he  wrote  this  article  Mr.  Edlin  was 
in  his  final  year  of  undergraduate  study  in 
pharmacy  at  the  University  of  Cincinnati.  He 
is  now  doing  graduate  work  in  pharmacy  at  the 
Medical  College  of  Virginia. 


worked  under  him,  for  he  was  skilled  and 
had  learned  by  following  the  precepts  and 
examples  of  the  expert  who  taught  him. 

In  those  same  days,  the  preceptor  looked 
upon  the  task  of  training  his  successors  with 
the  same  inviolate  responsibility  that  he  pur- 
sued his  professional  duties  or  his  craft.  He 
took  great  pride,  and  properly  so,  in  the  rigid 
integrity  of  his  performance.  It  is  small  won- 
der that  those  fortunate  enough  to  serve  and 
learn  under  such  masters  considered  it  a 
privilege.  They  remembered  and  followed 
his  directives  throughout  life,  for  they  were  a 
sacred  trust. 

Changing  Times 

Of  course,  times  have  changed.  We  no 
longer  depend  on  such  haphazard  methods 
when  we  start  on  our  path  to  pharmacy. 
Schools  and  colleges,  state  and  federal  agen 
cies,  laws,  associations  and  organizations, 
books  and  professional  literature  — all  these 
factors  have  paved  our  educational  roads  and 
are  leading  us  into  a profession  which  is 
steadily  advancing  toward  higher  standards. 

At  the  same  time,  through  all  the  meta- 
morphoses and  advances  of  our  profession 
and  of  education,  apprenticeship  has  re- 
mained a necessary  part  in  our  strife  for 
learning.  We  realize  no  school  or  book  can 
teach  us  enough  of  actuality,  and  that  there 
can  be  no  substitute  for  doing  things  rou- 
tinely. The  apprentice,  anxious  and  willing 


— 67  — 


SOUTH  DAKOTA 


to  learn  about  reality,  has  remained  the  same 
throughout  the  centuries.  But  what  has  be- 
come of  the  preceptor? 

Economic  considerations  are  partially  the 
reason  for  the  situation  which  is  revealed  in 
my  survey  and  other  surveys.  Low  wages  for 
the  apprentice  (sanctioned  by  the  minimum 
wage  law)  can  be  overlooked  if  the  time  and 
effort  spent  on  training  are  equivalent  to  the 
difference  in  money. 

But  is  this  generally  the  case?  Recent  sur- 
veys have  shown  that  only  about  half  as  much 
can  be  earned  by  working  in  a drugstore  as 
can  be  earned  at  jobs  in  other  fields.  Do  the 
benefits  derived  from  the  program  warrant 
this  sacrifice? 

Responsibility  for  Teaching 

The  public  school  teacher,  faced  with  the 
colossal  task  of  teaching  all  the  standard 
courses,  plus  decent,  civilized  behavior,  is 
overwhelmed.  He  often  times  accepts  conduct 
which  a few  decades  ago  would  have  led  to 
the  student’s  expulsion.  The  responsibility 
for  teaching  better  morals  and  behavior  is 
placed  on  the  church,  synagogue,  or  on  some 
public  official  or  group. 

It  is  quite  obviously  a hopeless  matter  to 
expect  the  parents  to  take  some  interest  or 
action  at  this  late  date  if  they  have  not  al- 
ready done  so. 

So  it  goes  throughout  our  present  way  of 
life  — the  responsibility  which  once  was  as- 
sumed by  men  and  women  in  the  home  and 
in  the  community  is  all  too  frequently 
shunned.  The  current  philosophy  is  “Let 
someone  else  do  it.” 

Even  the  professions  have  been  influenced 
by  this  trend.  Many  pharmacists  complain 
that  young  men  and  women  after  graduation 
and  licensure  show  a serious  lack  of  practical 
knowledge,  and,  accordingly,  are  unable  to 
do  many  tasks  assigned  to  them.  For  this,  the 
colleges  are  blamed.  Yet,  every  one  of  these 
supposedly  awkward  and  unskilled  young 
people  has  a sworn  statement  from  some 
pharmacist  that  he  or  she  has  worked  under 
his  personal  supervision  for  a full  year.  This 
time  was  presumably  spent  with  the  phar- 
macist-preceptor showing  the  young  appren- 
tice the  know-how  which  is  part  of  the  pro- 
fession and  which  cannot  be  learned  from 
books. 

Practical  Experience  Often  Negligible 

That  the  practical  experience  obtained 


often  is  of  negligible  value  is  well  known. 
The  “Pharmaceutical  Survey,”  as  one  of  its 
recommendations,  suggested  that  practical 
experience  be  made  more  meaningful  or  its 
requirement  for  licensure  be  abolished.  No 
person  who  has  studied  this  problem  has 
concluded  that  good  practical  experience  is 
unimportant.  It  is  almost  a must  if  the  young 
pharmacist  is  to  render  the  best  professional 
service  and  do  it  with  efficiency  and  dispatch. 

Many  pharmacists,  aware  of  the  low  qual- 
ity of  much  of  the  practical  experience  now 
being  certified,  are  suggesting  that  the  col- 
leges should  regulate  this  aspect  of  the  stu- 
dent’s training  as  well  as  his  academic  pro- 
gram. 

Does  this  not  smack  the  same  philosophy 
as  that  the  parent  who  expects  the  school 
teacher  to  train  the  child  to  dress  and  care 
for  himself?  Is  the  training  of  the  phar- 
macists of  no  personal  concern  or  obligation 
to  those  already  in  practice?  Can  we  expect 
to  have  a coherent,  well-knit  profession  if 
each  pharmacist  feels  no  obligation  to  give 
some  of  his  time  and  effort  to  those  who  some 
day  must  carry  on? 

Pharmacists  Evaluate  Pharmacy  Students 

The  following  is  an  outline  of  some  of  the 
salient  points  of  the  thinking  of  pharmacists 
in  general  toward  apprentice: 

(1)  You  look  upon  students  as  you  do  any 
other  hired  help,  except  that  they  are  more 
demanding.  This  you  compensate  for  by 
lower  salaries. 

(2)  They  are  in  my  store  to  do  a job  — a 
little  more  perhaps  — certainly  no  less.  If 
you  don’t  get  your  money’s  worth  the  student 
won’t  be  with  you  for  long. 

(3)  The  student’s  education  is  in  no  way 
your  responsibility.  Students  are  with  you 
to  work  — every  time  your  requirement  de- 
mands it.  School  is  the  place  to  get  educated, 
and  you  are  not  above  taking  a verbal  hay- 
maker at  what  they  are  learning. 

(4)  Students  are  practically  worthless  until 
they  become  seniors. 

(5)  They  haven’t  the  background  to  be 
trusted  within  the  confines  of  the  inner  sanc- 
tum. 

(6)  Some  of  you  might  even  go  as  far  as 
not  letting  them  dispense  a dozen  Empirin 
Compound  from  the  Schwartz  Cabinet. 

(7)  Read  a prescription  — fill  one  under 
supervision?  Some  of  you  — never  would 


— 68 


FEBRUARY  1958 


allow  it  to  be  done. 

Gentlemen,  who  are  you  trying  to  fool? 
What  are  you  trying  to  hide?  What  are  you 
trying  to  protect?  Are  you  confident  of  your 
own  abilities  or  is  it  that  you  are  afraid  new 
blood  will  lift  the  veil  of  mysticism  that  sur- 
rounds the  prescription  room?  The  veil  has 
already  been  lifted;  almost  anyone  except 
pharmacy  students  (?)  can  read  prescriptions 
today. 

What  the  Apprentice  Should  Expect  from 
His  Preceptor 

If  the  last  heading  and  paragraph  doesn’t 
categorize  you  as  described,  then  you  have  no 
reason  to  get  unduly  upset  — ■ I am  addressing 
those  who  do  belong  in  that  category;  there 
are  a considerable  number. 

If  you  are  not  wearing  the  “categorized 
pair  of  shoes,”  but  stand  in  a more  present- 
able pair,  you  may  be  wondering  what  you 
can  do  to  shine  them  up  a bit.  You  may  be 
wondering  what  can  be  done  to  improve  the 
training  during  apprenticeship. 

What  can  be  done  is  limited  only  by  your 
imagination,  your  own  abilities,  your  avail- 
able physical  resources,  and  most  of  all  the 
desire  to  do  something.  Much  can  be  done 
even  with  limited  resources  and  low  pres- 
cription volume;  and  I shall  confine  my  view- 
points to  the  purely  professional  phases. 

I will  simply  enumerate  some  of  the  things 
which  should  be  learned  in  the  store.  When 
they  are  done  depends  both  upon  the  individ- 
ual student  and  upon  his  stage  of  training. 
There  are  certain  things  that  any  student  can 
learn,  even  freshmen  and  sophomores,  al- 
though the  former  should  not  be  working  in  a 
store.  Many  of  you  have  had  little  or  no 
formal  training  and  still  more  of  you  are 
proud  of  what  you  learned  before  you  ever 
started  pharmacy  school.  Why  are  things  so 
different  today? 

An  apprentice  should: 

1.  Learn  to  read  prescriptions.  The  store 
is  the  best  place  to  learn  this. 

2.  Have  an  opportunity  to  discuss  prescrip- 
tions with  his  preceptor  from  time  to  time. 

3.  Be  taught  to  use  apothecary  and  metric 
weights  as  early  as  possible.  Furthermore, 
he  should  be  taught  the  practical  aspects  of 
estimating  dosages,  when  extreme  accuracy 
is  essential,  and  when  exact  equivalents  are 
used  behind  the  prescription  counter. 

4.  Have  an  opportunity  to  fold  powders 


and  pack  capsules. 

5.  Become  familiar  with  all  new  drugs  — • 
learning  dose,  category,  and  appearance. 

6.  Maintain  a notebook  and  be  questioned 
on  it  before  his  practical  examination. 

7.  Fill  prescriptions.  Second  and  third  year 
students  have  had  galenical  pharmacy  and 
inorganic  chemistry;  they  should  be  per- 
mitted to  fill  prescriptions  for  which  this 
background  suits  them.  Proper  supervision 
is  always  presupposed. 

8.  Properly  record  everything  new  that  is 
done.  It  is  better  to  fill  two  prescriptions  per 
day,  writing  up  all  details  about  pharma- 
cology, dosage,  etc.,  than  it  is  to  fill  forty  and 
learn  nothing  other  than  stock  location  and 
variations  in  physicians’  handwriting.  The 
latter  is  important,  but  should  not  take  pre- 
cedence over  the  former. 

9.  Be  responsible  for  the  pharmacology, 
use,  and  visual  identification  of  each  new 
product  dispensed.  State  boards  (Ohio  Phar- 
macist Editor’s  note:  Ohio,  too.)  are  requir- 
ing visual  identification  and  a thorough 
knowledge  of  these  materials.  The  precep- 
tor’s chances  of  bringing  about  familiarity 
with  them  are  far  better  than  those  of  the 
college. 

10.  Be  responsible  for  keeping  up  to  date 
the  file  on  manufacturers  literature,  product 
information  cards,  and  other  information. 

11.  Be  responsible  for  maintaining  the  li- 
brary — adequate,  but  not  necessarily  ex- 
tensive — in  the  pharmacy. 

Dear  Fellow  Students 

While  making  recommendations  to  our  em- 
ployer-preceptors, let  us  also  consider  a few 
of  our  own  responsibilities. 

What  I have  written  in  this  article  will 
never  have  any  meaning  if  we,  the  appren- 
tices, do  not  live  up  to  and  take  advantage  of 
the  opportunities  and  standards  presented 
by  our  profession. 

Let  us  show  that  we  are  willing  to  learn, 
and  to  perform  our  best  in  all  phases  of  work 
encountered  in  the  drugstores  in  which  we 
are  employed.  It  is  not  beyond  anyone  of  us 
to  pick  up  a broom  or  mop  or  make  an  ice- 
cream soda.  We  cannot  pass  the  State  Board 
or  thereafter  efficiently  practice  pharmacy 
by  only  knowing  the  price  of  cigars. 

Let  us  always  keep  in  mind  that  an  efficient 
preceptor  devotes  a great  deal  of  his  time  and 


— 69  — 


SOUTH  DAKOTA 


energy  to  trying  to  teach  us  to  be  an  efficient 
and  adept  pharmacist;  let  us  be  equally  ef- 
ficient. Let  us  remember  The  Golden  Rule, 
“Do  unto  others  as  you  would  have  them  do 
unto  you.” 

In  Conclusion:  Never  Too  Old 

The  preceptor,  who  through  his  under- 
standing and  cooperation  gains  the  confi- 
dence and  good  will  of  the  student,  never 
grows  old.  None  of  us  is  too  old  to  learn. 
The  wise  pharmacist,  while  he  teaches  the 
apprentice  many  practical  points,  avails  him- 
self of  the  splendid  opportunity  of  being 
kept  up  to  date  on  new  advances  and  new 
theories  learned  in  college. 

Such  a give  and  take  arrangement  is  ideal, 
for  it  produces  a fine  sense  of  professional 
comradeship  and  competence. 

How  much  better  this  is  than  for  the  phar- 
macist to  belittle  and  scoff  at  the  material 
being  given  by  the  colleges  as  to  theoretical, 
idealistic,  or  impractical  simply  because  he  is 
ashamed  to  confess  his  ignorance.  The  long- 
term benefits  of  this  mutual  aid  are  many, 
not  least  among  which  is  the  desire  of  the 
young  pharmacist  to  cooperate  and  work 
with  others,  and  to  believe  in  organization 
and  united  effort.  The  need  for  such  a spirit 
of  cooperation  in  our  profession  is  well 
known. 

Food  for  Thought 

Experience  is  a legal  prerequisite  to  licen- 
sure. Is  the  spirit  of  the  law  fulfilled  if  stu- 
dents are  left  alone  in  stores  or  allowed  to 
fill  prescriptions  without  being  supervised  or 
checked?  Or  will  we  be  able  to  make  good 
pharmacists  out  of  students  who  have  spent 
their  apprenticeship  filling  in  the  “pop  case” 
and  sweeping  the  floor?  Would  different 
legislation,  state  or  school  supervision,  or  ap- 
proval of  the  stores  employing  apprentices  be 
possible,  and,  if  so,  would  it  change  the  situa- 
tion? Should  we  be  optimistic  and  hope  for  a 
turn  for  the  better?  Should  we  be  happy  that 
conditions  are  not  any  worse? 

I do  not  know  the  answers.  I do  know, 
however,  it  does  not  make  sense. 


ANIMAL  HEALTH  PHARMACY— 
FEBRUARY.  1958  ADVERTISERS 

(Continued  from  Page  66) 
used  as  a standard  preparation  against  glad- 
iolus thrips  and  fruit  flies. 

Formaldehyde  or  formalin,  CH2O,  1 part, 
sugar  2 parts,  water  30  parts,  has  been  used 
as  a poison  bait  for  house  flies.  It  has  also 
been  used  to  treat  potatoes  for  the  scab  gnat. 

Thallous  sulfate,  TI2SO4,  and  thallous  ace- 
tate, TlCOOCHs  are  sometimes  used  in  ant 
and  rodent  baits.  These  compounds  are  sol- 
uble in  water  and  are  of  sufficient  toxicity 
so  that  some  state  laws  restrict  possession  of 
them.  Five  tenths  of  1 per  cent  to  4 per  cent 
preparations  are  used  for  house  ants  and  fire 
ants,  while  a 1 per  cent  concentration  in  grain 
is  used  in  rodent  control. 

Yellow  phosphorus,  flamable  at  34°C,  is 
made  into  pastes  by  grinding  in  water  and 
mixing  with  flour  for  the  control  of  American 
and  Oriental  roaches.  It  is  very  toxic  to 
mamals  and  is  therefore  sometimes  used  as  a 
rodenticide,  expecially  for  rats  and  mice. 
Because  of  the  danger  of  poisoning  to  other 
mamals  accidently,  yellow  phosphorus  is 
being  replaced  as  an  insecticide  by  the  newer 
organic  compounds. 

Zinc  phosphide,  Zn3P2,  is  spontaneously 
flamable  with  acids.  Insoluble  in  water,  it  is 
used  for  controlling  mosquito  larvae.  Cau- 
tions should  be  observed  in  handling  it. 
About  a 1 per  cent  bait  is  used  as  a rodenti- 
cide. 

Sodium  selenate,  Na2Se04,  and  potassium 
ammonium  selenosulfide,  (KNH4S)3Se,  1 part 
to  500-800  parts  of  water  have  been  used  to 
control  red  spider  mites.  Absorbed  selenium 
compounds  on  ornamentals  essentially  elim- 
inate some  insects,  ie.,  the  chrysanthemum 
aphid,  when  the  foliage  contains  45  parts  per 
million.  Because  of  the  danger  of  poisoning 
from  fruits  and  vegetables,  it  is  advisable  to 
restrict  the  use  of  selenium  compounds  to 
ornamentals. 


— 70  — 


Fellow  Pharmacists: 

Another  new  year  has  rolled  around  and  I’m  hoping  that  all  of  you  had  a very  successful 
1957.  The  indications  and  forecasts  are  for  good  business  in  the  future  and  I wish  you  all  a 
prosperous  year  in  1958. 

I personally  feel  that  the  profession  of  pharmacy  has  made  great  strides  forward  during 
the  past  years  and  that  we  will  continue  to  go  forward  in  the  years  to  come.  This  is  especially 
true  with  the  professional  aspects  of  pharmacy,  in  the  area  of  public  relations  and  in  our 
relations  with  the  allied  professions  of  the  health  team. 

Let  us  endeavor  to  make  1958  better  than  preceding  years  in  our  continuing  fight  to  raise 
the  standards  of  pharmacy. 

Sincerely, 

George  Lehr 


k. 


__71  — 


Dartal 

Description:  Dartal  is  chemically  described  as 
l-(2-acetoxyethyl)-4-[/]3-(2-chloro-10-pheno-- 
thiazinyl)propyl[/]piperazine  dihydrochlor- 
ide. 

Indications:  In  the  treatment  of  the  agitated 
and  anxiety  states  associated  with  insom- 
nia, anorexia,  abnormal  excitement,  the 
psychosomatic  symptoms  of  organic  dis- 
orders such  as  peptic  ulcer,  cerebral  arter- 
iosclerosis, catatonic  or  paranoid  schizo- 
phrenia, neuroses,  psychoses,  acute  mania, 
Huntington’s  chorea,  barbiturate  addiction 
and  alcoholism.  Dartal  supplies  tranquil- 
izing  effects  without  sedation  and  accom- 
plishes this  effectively  on  low  dosages. 

Dosage:  The  recommended  dose  for  anxiety 
tension  states,  psychosomatic  disease  and 
other  neuroses  is  5 mg.  three  times  daily 
and  for  psychotic  conditions  it  is  10  mg. 
three  times  daily.  These  daily  dosages 
should  be  individually  adjusted  upward  or 
downward  in  units  of  5 or  10  mg.,  at  inter- 
vals of  three  or  four  days.  Dartal  has  been 
shown  to  have  a high  order  of  saftey  but 
an  extrapyramidal  activity  of  pseudopark- 
insonism may  occur  on  high  dosage.  This 
can  be  controlled  by  reducing  or  discontin- 
uing Dartal  or  when  continuing  therapy  is 
imperative  by  concurrently  administering 
antiparkinson  drugs. 

Dosage  Form:  Tablets,  uncoated,  white,  5 mg., 
in  bottles  of  50  and  500.  Tablets,  uncoated, 
peach,  10  mg.,  in  bottles  of  50  and  500. 

Source:  G.  D.  Searle  & Co. 


Wyanoids  HC 

Description:  Each  suppository  contains  hy- 
drocortisone (as  acetate),  10  mg.;  extract 
belladonna,  0.5%  (equiv.  total  alkaloids, 
0.0063%);  ephedrine  sulfate,  0.1%;  zinc 
oxide,  boric  acid,  bismuth  oxyiodide,  bis- 
muth subcarbonate,  and  balsam  peru  in  an 
oleaginous  base. 

Indications:  Wyanoids  HC  is  indicated  for  the 
treatment  of  acute  and  chronic  nonspecific 
proctitis,  radiation  proctitis,  proctitis  ac- 
companying ulcerative  colitis,  medication 
proctitis,  acute  internal  hemmorrhoids, 
cryptitis,  post-operative  scar  tissue  with  in- 
flammatory reaction,  and  internal  anal 
pruritus. 

Dosage:  One  suppository  rectally  twice  daily 
for  six  days  or  as  required. 

Dosage  Form;  Suppositories,  boxes  of  12. 

Source:  Wyeth  Laboratories. 

Furoxone  Aerodust- Veterinary 

Description:  Furoxone  Aerodust- Veterinary 
contains  25%  Furoxone,  brand  of  furazoli- 
done, practical  grade,  in  a special  base.  It 
is  applied  with  a dust  applicator. 

Indications:  Furoxone  Aerodust- Veterinary  is 
used  in  chickens  for  the  flock  treatment  of 
chronic  respiratory  disease  (CRD  or  air  sac 
infection). 

Dosage:  The  contents  of  a 100-gram  container 
are  sufficient  to  treat  1,000  chickens.  The 
dust  cloud  is  directed  about  2 feet  over  the 
birds  from  a distance  of  5 to  6 feet  from  the 
nearest  bird.  If  necessary,  treatment  may 
be  repeated  at  48-hour  intervals. 


— 72  — 


FEBRUARY  1958 


Dosage  Form:  In  container  of  100  grams.  To 
veterinarians  only. 

Source:  Eaton  Laboratories,  Norwich,  N.  Y. 

Cortrophin-Zinc  Disposable  Syringe 

Description:  Each  Cortrophin-Zinc  disposable 
syringe  unit  contains  a 1-cc  cartridge  pro- 
viding 40  USP  units  of  purified  corticortro- 
pin  in  a fine  aqueous  suspension.  The 
ACTH  is  adsorbed  on  zinc  hydroxide  for 
repository  action. 

Indications:  Cortrophin-Zinc  supplies  pitui- 
tary corticotropin  to  stimulate  the  adrenal 
cortex  to  produce  its  essential  corticos- 
teroids in  physiologic  proportions  over  a 
longer  period  than  would  be  the  case  with 
equal  amounts  of  any  other  type  of  ACTH. 
It  is  indicated  in  the  treatment  of  allergic 
reactions,  theumatoid  disorders,  derma- 
tologic and  eye  diseases,  and  in  all  other 
conditions  amenable  to  ACTH  therapy,  es- 
pecially where  natural  stimulation  of  the 
adrenal  cortex  is  desired.  Dosage  must  be 
adjusted  to  the  individual  needs  of  each  pa- 
tient. 

Dosage  Form:  Cortrophin-Zinc  disposable 
syringes  are  available  in  packages  of  1 and 
in  sleeves  of  3. 

Source:  Organon  Inc. 

Liquaemin  Sodium  Disposable  Syringe 

Description:  Each  Liquaemin  Sodium  sterile 
disposable  syringe  unit  contains  a 1-cc  cart- 
ridge providing  20,000  USP  units  (200  mg.) 
of  heparin  sodium  in  an  aqueous  solution. 

Indications:  Liquaemin  Sodium  is  indicated 
in  the  treatment  of  thromboembolic  dis- 
orders and  in  every  condition  requiring 
anticoagulant  therapy. 

Dosage  Form:  Liquaemin  Sodium  sterile  dis- 
posable syringes  are  packaged  in  boxes  of  1. 

Source:  Organon  Inc. 

Midicel 

Description:  A new  sulfa  compound,  sulfame- 
thoxypridazine,  designed  chemically  as  3- 
sulfanilamido-6-methoxypyridazine. 

Indications:  The  treatment  of  many  gram- 
negative and  gram-positive  bacterial  infec- 
tions. It  is  particularly  appropriate  in  treat- 
ing patients  with  infections  of  the  urinary 
tract. 

Dosage:  One  gram  (two  tablets)  daily,  fol- 
lowed by  0.5  gram  (one  tablet)  daily  or  two 
tablets  every  other  day  for  mild  infections. 
For  severe  infections  an  initial  dose  of 


four  tablets  followed  by  one  daily  is  recom- 
mended, children’s  dosage  according  to 
weight. 

Dosage  Form:  In  bottles  of  24  and  100  quar- 
ter-scored tablets,  each  tablet  containing 
0.5  Gm.  of  sulfamethoxypyridazine. 

Source:  Parke-Davis. 

Pen-Vee  L-A 

Description:  A new  long-acting  form  of  peni- 
cillin V.  Each  orange  and  yellow  Pen-Vee 
L“A  tablet  contains  250  mg.  (400,000  units) 
of  phenoxymethyl  penicillin  (penicillin 
V). 

Indications:  Pen-Vee  L-A  tablets  are  in- 
dicated for  most  infections  caused  by  or- 
ganisms susceptible  to  penicillin  therapy, 
particularly  those  due  to  hemolytic  strep- 
tococci, pneumococci,  gonococci  and  some 
staphylococci.  The  drug  is  highly  useful 
in  preventing  bacterial  invasion  in  patients 
with  a history  of  rheumatic  fever  or  rheu- 
matic or  congenital  heart  disease.  It  is  in- 
dicated also  for  prophylaxis  against  sub- 
acute bacterial  endocarditis  following  ton- 
sillectomy and  tooth  extraction. 

Dosage:  Hemolytic  streptococcal  and  suscep- 
tible straphylococcal  infections,  one  tablet 
t.i.d.  Pneumococcal  infections,  one  tablet 
every  six  to  eight  hours  for  five,  or  six 
days.  Gonococcal  infections,  one  tablet 
every  four  to  six  hours  for  two  or  three 
doses.  (In  gonorrheal  complications,  pro- 
longed and  intensive  therapy  is  required.) 
To  prevent  recurrent  attacks  of  rheumatic 
fever,  one  tablet  daily.  As  a prophylaxis 
against  bacterial  endocarditis,  one  tablet 
every  eight  hours  from  one  day  before  to 
four  days  after  tonsillectomies  and  tooth 
extractions. 

Dosage  Form:  Tablets,  vials  of  24. 

Source:  Wyeth  Laboratories. 

Peritraie  With  Phenobarbital 

Description:  Peritrate  (pentaerythritol  tetra- 
nitrate)  20  mg.  and  phenobarbital  15  mg.  in 
a monogrammed,  scored  tablet;  yellow  in 
color. 

Indications:  Coronary  vasodilator  for  pro- 
phylactic treatment  of  angina  pectoris  and 
post-coronary  disease,  especially  in  cases 
where  relief  of  fear  and  apprehension  with- 
out daytime  drowsiness  is  desirable.  Helps 


— 73  — 


SOUTH  DAKOTA 


reduce  apprehension  and  restlessness 
through  the  addition  of  phenobarbital’s 
mild  sedative  effect  to  Peritrate’s  coronary 
vasodilating  action.  Especially  useful  dur- 
ing initial  stages  of  therapy  in  the  post- 
coronary or  angina  patient. 

Dosage  Form:  Bottles  of  100  and  500  tablets. 

Special  Note:  Each  bottle  of  Peritrate  20  mg. 
with  Phenobarbital  will  be  shipped  with  a 
bottle  hanger  tag  for  the  pharmacist’s 
product  information  file.  The  readily  re- 
movable card  provides  rapid  information 
to  both  the  pharmacist  and  inquiring  phys- 
ician. 

Source:  Warner-Chilcott  Laboratories. 

Cardilate 

Description:  Each  scored  tablet  containing  15 
mg.  of  Erythrol  Tetranitrate,  taken  sub- 
lingually or  buccally,  provides  prolonged 
prophylaxis  of  angina  pectoris  attacks. 

Indications:  As  the  action  of  ‘Cardilate’  is 
somewhat  slower  than  that  of  nitroglycerin, 
is  is  not  intended  for  the  treatment  of  acute 
attacks  of  angina  pectoris.  Instead  it  is  de- 
signed for  the  prophylactic  and  long-term 


treatment  of  patients  with  frequent  or  re- 
current anginal  pain.  The  beneficial  effect 
of  ‘Cardilate’  in  the  treatment  of  angina 
pectoris  is  attributed  to  increased  coron- 
ary blood  flow,  which  has  been  shown  to 
occur  in  both  systole  and  diastole  and  is 
the  result  of  decreased  vascular  tone  or 
resistance.  With  increased  coronary  blood 
flow  and  unchanged  cardiac  work,  the 
effective  blood  supply  to  the  myocardium 
is  increased.  This  is  the  basis  for  the  relief 
of  myocardial  ischemia  and  its  associated 
anginal  pain. 

Dosage:  One  tablet  sublingually  or  in  the  buc- 
cal pouch  three  times  daily,  after  meals. 
For  those  who  are  subject  to  nocturnal  an- 
gina, an  additional  tablet  about  one  hour 
before  bedtime  is  recommended.  Up  to 
two  tablets  three  times  a day  are  well  toler- 
ated but,  as  with  nitroglycerin,  a temporary 
headache  is  more  apt  to  occur  with  larger 
doses. 

Dosage  Form:  Bottles  of  100. 

Source:  Burroughs  Wellcome  & Co. 


HOME  OFFICES 
ALGONA,  IOWA 

All  Policies  Non-Assessable 


//mmax 

INSURANCE  COMPANY  OF  IOWA 


1909 

1958 


""It  is  ten  times  easier  to  find  a million  dollars  worth  of  capital 
than  it  is  to  find  the  right  man  to  manage  it"" 

That  statement  of  24  words,  spoken  by  James  J,  Hill,  one  of  America's  pioneer  railroad 
builders,  neatly  sums  up  what  we  all  know  to  be  true. 

And  they  are  24  words  no  less  true  today  than  when  they  were  spoken  many  years  ago. 
Whatever  the  size  of  a business,  its  success  stems  from  "good  management." 

Over  many  years  now  totaling  almost  half  a century,  we  at  Druggists'  Mutual  have  had 
the  privilege  of  observing  the  excellent  results  of  "good  management"  in  hundreds  of  suc- 
cessful drug  store  operations. 

We  are  deeply  proud  of  the  fact  that  Druggists'  Mutual  specialized  insurance  services 
have  been  part  and  parcel  of  these  successful  operations  — "good  and  wise  management." 


! 


_74__ 


w 


PHARMACV 


72nd  CONVENTION 
SCHEDULE  SET 

The  schedule  of  events  for 
the  72nd  annual  convention 
of  the  South  Dakota  Pharma- 
ceutical Association  has  been 
set  by  the  local  convention 
committee.  The  convention 
will  be  held  at  Brookings 
Sunday,  June  22  through 
Wednesday,  June  25. 

One  of  the  features  of  the 
convention  program  this  year 
will  be  State  College  Day, 
Starting  with  an  alumni 
breakfast,  the  day  will  in- 
clude speakers  on  profes- 
sional aspects  of  pharmacy, 
campus  tours  and  the  annual 
association  banquet  in  the 
evening. 

In  announcing  the  conven- 
tion schedule  the  committee 
pointed  out  that  reservations 
for  housing  during  the  con- 
vention should  be  made  at  an 
early  date  due  to  the  heavy 
volume  of  tourist  business 
usually  accommodated  in  the 
Brookings  area  during  June. 

The  program  schedule  for 
the  convention  is; 

SUNDAY.  JUNE  22 
12:00  M Registration,  Elks 
Club 

Sports,  Brookings 
Country  Club 

Exhibits,  Elks  Club 


6:30  P.M.  Allied  Drug 

Travelers’  Party,  Brook- 
ings Country  Club 
MONDAY,  JUNE  23 

8:30  A.M.  Past  President’s 
Breakfast,  Elks  Club 
10:00  A.M.  First  General 
Session,  High  School 
Auditorium 

12:00  M Luncheon,  Elks 
Club 

1:30  P.M.  Second  General 
Session,  High  School 
Auditorium 

8:00  P.M.  Variety  Show, 
High  School  Auditorium 
TUESDAY.  JUNE  24 

STATE  COLLEGE  DAY 

8:30  A.M.  Alumni 

Breakfast,  Elks  Club 
10:00  A.M.  Pharmaceutical 
Institute,  First  Session, 
Bunny  Ballroom, 
Union  Building 
12:00  M.  Luncheon,  Main 
Ballroom,  Union  Build- 
ing 

1:30  P.M.  Pharmaceutical 
Institute,  Second  Session, 
Bunny  Ballroom, 
Union  Building 

6:30  P.M.  Annual  Associa- 
tion Banquet,  Entertain- 
ment and  Dance,  Main 
Ballroom,  Union 
Building 

WEDNESDAY,  JUNE  25 

8:30  A.M.  Veteran’s 


Breakfast,  Elks  Club 
10:00  A.M.  Third  General 

Session,  High  School 
Auditorium 

12:00  M Luncheon,  Elks 
Club 

1:30  P.M.  Closed  Business 
Session,  High  School 
Auditorium 


SIOUX  FALLS 
PHARMACY  ASSN. 
MEETS 

The  Sioux  Falls  Pharmacy 
Association  met  December 
11th  at  Stacy’s  Cafe.  Sales 
tax  on  prescriptions  and  in- 
sulin was  brought  up,  and 
both  pros  and  cons  of  the 
matter  discussed.  It  was 
tabled  for  investigation. 
Plans  for  the  1st  annual 
Christmas  mixer  were  out- 
lined by  Murray  Widdis,  Jr. 

The  mixer  was  held  De- 
cember 14th  at  the  Town 
Club  with  an  excellent  turn 
out.  The  big  door  prize  of  a 
portable  T.V.  set  was  won  by 
Ron  Byer.  Food,  drinks, 
prizes,  etc.  were  furnished 
by  various  wholesales  and 
drug  stores. 


— 75  — 


SOUTH  DAKOTA 


FIFTEEN  PASS 
JANUARY  BOARD 
EXAM 

Fifteen  candidates  passed 
the  South  Dakota  State 
Board  Examination  for  Reg- 
istered Pharmacist  at  Brook- 
ings January  8.  The  oral  and 
practical  portions  of  the  state 
examinations  were  given. 
The  candidates  had  already 
taken  the  written  portions 
and  fulfilled  state  law  by 
completing  the  internship  re- 
quirement before  taking  the 
practical. 

Those  appearing  are: 
Duane  Bagaus,  Rochester, 
Minn.;  Mrs.  Ruth  A.  Bassett, 
Huron;  John  Borchert,  Rapid 
City;  Mrs.  Corinne  Christen- 
sen, Brookings;  Robert 
Ehrke,  Aberdeen;  David 
Johnson,  Amery,  Wisconsin; 
Emanuel  Kautz,  Pierre;  Al- 
fred Kleinsasser,  Freeman, 
Gerald  Martinka,  New  Aim, 
Minn.;  Stanley  Newbury, 
Yankton;  Kenneth  Odell, 
Sioux  Falls;  Richard  Peter- 
sen, Marshall,  Minn.;  Walter 
Peterson,  Sioux  City;  Mrs. 
Mary  Lou  Ehrke,  Mitchell; 
and  Oliver  White,  Billings, 
Montana. 

In  addition  Edward  Gar- 
rity,  Mitchell,  was  granted 
reciprocal  licensure. 

Board  members  present  at 
the  examination  were  Harold 
L.  Tisher,  President,  Yank- 
ton; Thomas  K.  Haggar, 
Watertown;  and  Harold  W. 
Mills,  Rapid  City.  Secretary 
Bliss  C.  Wilson  and  Inspector 
Glenn  E.  Velau  assisted  with 
the  examination. 


ESTABLISH  PHARMACY 
SCHOLARSHIP 

A $250  scholarship  will  be 
awarded  to  the  outstanding 
student  entering  the  senior 
year  of  pharmacy  at  South 
Dakota  State  College  as  the 
result  of  a grant  from  a 
group  of  State  College  phar- 
macy alumni. 

The  scholarship  will  be 
awarded  this  spring  to  a jun- 
ior student  chosen  by  the 
pharmacy  faculty  to  be  the 
most  deserving  student  en- 
tering the  senior  year  next 
fall. 

Established  in  the  name  of 
the  Northern  Ohio  Alumni 
Association  of  the  Division 
of  Pharmacy  of  South  Da- 
kota State  College,  the 
scholarship  is  from  that 
newly-organized  group. 

President  of  the  associa- 
tion is  C.  Wayne  Dyball  of 
the  class  of  1938.  Secretary- 
treasurer  is  Robert  Gruetz- 
macher  of  the  class  of  1934. 
Other  members  and  their 
classes  are  William  Sargent 
1933,  Edward  Fischer  1934, 
Robert  Joseph  1935,  Delmar 
DeBuhr  1938,  Francis  H. 
Cooper  1939,  and  Leo  Sher- 
man 1950. 


PHARMASCOOPS 
Tom  Hagger  and  Floyd 
Cornwell  were  members  of 
a group  of  civic  officials 
meeting  recently  with  Sena- 
tor Francis  Case  in  Aberdeen 
with  regard  to  the  possible 
establishment  of  a missile 
base  in  the  area.  Hagger  is 
a Watertown  pharmacist, 
member  of  the  South  Dakota 
State  Board  of  Pharmacy  and 
president-elect  of  the  Water- 
town  Chamber  of  Commerce. 
Cornwell,  a former  member 
of  the  board  of  pharmacy  is 
a Webster  pharmacist  and 


Mayor  of  that  city. 

Connie  Lien,  Beaver  Creek, 
Minn,  was  recently  united  in 
marriage  to  Richard  Eitreim, 
Garretson.  Eitreim  grad- 
uated in  pharmacy  from 
South  Dakota  State  College 
in  1953  and  has  been  man- 
ager of  the  Johnson  Drug 
Company  in  Garretson.  The 
couple  will  make  their  home 
in  Tacoma,  Washington. 

Six  State  College  Phar- 
macy graduates  have  com- 
pleted 15  weeks  of  training 
in  the  Medical  Service  Corps 
at  Gunter  Air  Force  Base, 
Montgomery,  Alabama  and 
have  been  reassigned  to  duty 
as  indicated.  Lt.  Gene  Buck- 
ley  will  be  assigned  to 
Ramey  Air  Force  Base  in 
Puerto  Rico;  Lt.  Ronald 
Beatty  to  Selfridge  Air  Force 
Base,  Michigan;  Lt.  Robert 
Matson  to  Ardmore  Air 
Force  Base,  Oklahoma;  Lt. 
Douglas  Huewe  to  Long 
Beach,  California;  Lt.  Paul 
Schuchardt  to  Ellsworth  Air 
Force  Base,  Rapid  City  and 
Lt.  Jon  Hammer  will  go  to 
Japan. 

On  Christmas  Day,  a baby 
girl  was  born  to  Mr.  and  Mrs. 
Bob  Vander  Aarde,  Bel  Aire 
Drug  of  Sioux  Falls.  They 
now  have  2 boys  and  2 girls. 

Don  Lien,  Luverne,  Minn- 
esota, senior  pharmacy  stu- 
dent was  recently  inducted 
into  the  Rho  Chi  Honorary 
Pharmaceutical  Society. 

Kay  Coffield,  Junior  phar- 

Mrs.  Byron  H.  Lawrence 
of  Brookings  has  enrolled  in 
the  graduate  division  of 
South  Dakota  State  College 
and  will  major  in  Pharma- 
ceutical Chemistry.  Mrs. 
Lawrence  holds  the  B.S.  de- 
gree in  pharmacy  from  North 
Dakota  State  College,  School 
of  Pharmacy 


— 76  — 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


29 


a Major  Breakthrough 
in  EDEMA- 
in  HYPERTENSION 


(CHLOROTHIAZIDE) 


EDEMA— 'DIURIL'  is  an  entirely  new,  orally  effec- 
tive, nonmercurial  diuretic— classed  as  the  most 
potent  and  most  consistently  effective  oral  agent  avail- 
able—with  activity  equivalent  to  that  of  the  parenteral 
mercurials.  It  has  no  known  contraindications. 

Indications:  Any  indication  for  diuresis  is  an  indica- 
tion for  'DIURIL'. 

Dosage:  One  or  two  500  mg.  tablets  of  'DIURIL'  once 
or  twice  a day. 

HYPERTENSION-'DIURIL'  improves  and  sim- 
plifies the  management  of  hypertension : it  potentiates 
the  action  of  antihypertensive  agents  and  often 
reduces  dosage  requirements  for  such  agents  below 
the  level  of  distressing  side  effects. 

Indications:  Hypertension  of  any  degree  of  severity. 

Dosage:  One  250  mg.  tablet  'DIURIL'  two  times 
daily  to  one  500  mg.  tablet 'DIURIL'  three  times  daily. 

Supplied:  250  mg.  and  500  mg.  scored  tablets 
'DIURIL'  (Chlorothiazide),  bottles  of  100  and  1,000. 

'DIURIL'  is  a trademark  of  Merck  & Co.,  Inc. 


MERCK  SHARP  & DOHME 


i 


Division  of  MERCK  & CO.,  INC.,  Philadelphia  1,  Pa. 


now... 

unprecedented 

Sulfa 

therapy 


I Mew  authoritative  studies  show  that  Kynex 
dosage  can  be  reduced  even  further  than  that 
j recommended  earlier.^  Now,  clinical  evidence 
has  established  that  a single  (0.5  Gm.)  tablet 
jnaintains  therapeutic  blood  levels  extending 
oeyond  24  hours.  Still  more  proof  that  Kynex 
stands  alone  in  sulfa  performance— 

» Lowest  Oral  Dose  In  Sulfa  History— 0.5  Gm. 

■ (1  tablet)  daily  in  the  usual  patient  for  main- 
:enance  of  therapeutic  blood  levels 

' » Higher  Solubility —effective  blood  concentra- 
I :ions  within  an  hour  or  two 


SULFAMETHOXYPYRIDAZINE  LEDERLE 

NEW  DOSAGE 

The  recommended  adult  dose  is  1 Gm.  (2  tab- 
lets or  4 teaspoonfuls  of  syrup)  the  first  day, 
followed  by  0.5  Gm.  (1  tablet  or  2 teaspoonfuls 
of  syrup)  every  day  thereafter,  or  1 Gm.  every 
other  day  for  mild  to  moderate  infections.  In 
severe  infections  where  prompt,  high  blood 
levels  are  indicated,  the  initial  dose  should  be 
2 Gm.  followed  by  0.5  Gm.  every  24  hours. 
Dosage  in  children,  according  to  weight ; i.e., 
a 40  lb.  child  should  receive  1/4  of  the  adult 
dosage.  It  is  recommended  that  these  dosages 
not  be  exceeded. 


'»  Effective^  Antibacterial  Range— exceptional 
jffectiveness  in  urinary  tract  infections 

» Convenience— the  low  dose  of  0.5  Gm.  (1  tab- 
et)  per  day  offers  optimum  convenience  and 
acceptance  to  patients 


Tablets : 

Each  tablet  contains  0.5  Gm.  (7%  grains)  of  sulfamethoxy- 
pyridazine.  Bottles  of  24  and  100  tablets. 

Syrup : 

Each  teaspoonful  (5  cc.)  of  caramel-flavored  syrup  contains 
250  mg.  of  sulfamethoxypyridazine.  Bottle  of  4 fl.  oz.  <- 
1 Nichols,  R.  L.  and  Finland,  M.:  J.  Clin.  Med.  49:410,  1957. 


LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 
.'Reg.  U.S.  Pat.  Off. 


32 


S.D.j.O.M.  FEBRUARY  1958  - ADV. 


THE  SOUTH  DAKOTA  JOURNAL 
OF  MEDICINE 

300  First  National  Bank  Sioux  Falls,  S.  D. 

Subscription  $2.00  per  year  20c  per  copy 

CONTRIBUTORS 

MANUSCRIPTS:  Material  appearing  in  all  publi- 
cations of  the  Journal  of  Medicine  should  be  type- 
written, double-spaced  and  the  original  copy,  not 
the  carbon  should  be  submitted.  Footnotes  should 
conform  with  this  request  as  well  as  the  name  of 
author,  title  of  article  and  the  location  of  the  author 
when  manuscript  was  submitted.  The  used  manu- 
script is  not  returned  but  every  effort  will  be  used 


to  return  manuscripts  not  accepted  or  published 
by  the  Journal  of  Medicine. 

ILLUSTRATIONS:  Half-tones  and  zinc  etchings 
will  be  furnished  by  The  South  Dakota  Journal  of 
Medicine  when  satisfactory  photographs  or  draw- 
ings are  supplied  by  the  author.  Each  illustration, 
table,  etc.,  should  bear  the  author’s  name  on  the 
back.  Photographs  should  be  clear  and  distinct. 
Drawings  should  be  made  in  black  India  ink  on 
white  paper.  Used  illustrations  are  returned  after 
publication,  if  requested. 

REPRINTS:  Reprints  should  be  ordered  when 
galley  proofs  are  submitted  to  the  authors.  Type 
left  standing  over  30  days  will  be  destroyed  and 
no  reprint  orders  will  be  taken.  All  reprint  orders 
should  be  made  directly  to  the  South  Dakota 
Journal  of  Medicine,  300  First  Nat’l  Bank,  Sioux 
Falls,  South  Dakota. 


(Continued  from  Page  12) 

Committee  on  Civil  Defense 

L.  C.  Askwig,  M.D.,  Chr Pierre 

G.  J.  Bloemendaal,  M.D Ipswich 

P.  V.  McCarthy,  M.D - — Aberdeen 

Commission  for  Improvement  of  Patient  Care 
R.  Delaney,  M.D.,  Chr.  (1960)  Mitchell 

M.  Sanders,  M.D.  (1960)  Redfield 

C.  L.  Vogele,  M.D.  (1958)  Aberdeen 

C.  F.  Gryte,  M.D.  (1958)  Huron 

J.  A.  Muggly,  M.D.  (1959)  Madison 

R.  A.  Buchanan,  M.D.  (1959)  Huron 

Committee  on  School  Health 

R.  G.  Mayer,  M.D.,  Chr Aberdeen 

W.  A.  Anderson,  M.D Sioux  Falls 

N.  R.  Whitney,  M.D.  Rapid  City 

Committee  on  Budget  and  Audit 

A.  P.  Reding,  M.D.,  Chr Marion 

A.  A.  Lampert,  M.D Rapid  City 

C.  R.  Stoltz,  M.D Watertown 

Hunters  Fall  Medical  Meeting 

W.  A.  Delaney,  M.D.,  Chr.  Mitchell 

H.  R.  Lewis,  M.D _..Mitchell 

L.  W.  Tobin,  M.D Mitchell 

Committee  on  Aging 

Warren  Jones,  M.D.,  Chr ..Sioux  Falls 

J.  W.  Argabrite,  M.D Watertown 

M.  P.  Merryman,  M.D JRapid  City 

DISTRICT  OFFICERS 
DISTRICT  1 

President A.  Keegan,  M.D.,  Aberdeen,  S.  D. 

Vice-President  ... G.  H.  Steele,  M.D.,  Aberdeen,  S.  D. 

Secretary-Treasurer W.  E.  Gorder,  M.D.,  Aberdeen,  S.  D. 

DISTRICT  2 

President John  Stransky,  M.D.,  Watertown,  S.  D. 

Vice-President S.  W.  Allen,  Jr.,  Watertown,  S.  D. 

Secretary-Treasurer....M.  C.  Rousseau,  M.D.,  Watertown,  S.  D. 

DISTRICT  3 

President ..S.  E.  Friefeld,  M.D.,  Brookings,  S.  D. 

Vice-President ...C.  S.  Roberts,  Jr.,  M.D.,  Brookings,  S.  D. 

Secretar.v-Treasurer C.  M.  Kershner,  M.D.,  Brookings,  S.  D. 


DISTRICT  4 

President S.  B.  Simon,  M.D.,  Pierre,  S.  D. 

Vice-President R.  C.  Jahraus,  M.D.,  Pierre,  S.  D. 

Secretary-Treasurer J.  T.  Cowan,  M.D.,  Pierre,  S.  D. 


DISTRICT  5 

President Ted  Hohm,  M.D.,  Huron,  S.  D. 

Vice-President Roscoe  Dean,  M.D.,  Wess.  Springs,  S.  D. 

Secretary-Treasurer Fred  Leigh,  M.D.,  Huron,  S.  D. 

DISTRICT  6 

President  F.  D.  Gillis,  Jr.,  M.D.,  Mitchell,  S.  D. 

Vice-President D.  R.  Nelimark,  M.D.,  Mitchell,  S.  D. 

Secretary-Treasurer ...R.  J.  Delaney,  M.D.,  Mitchell,  S.  D. 


DISTRICT  7 

President  F.  C.  Kohlmeyer,  M.D.,  Sioux  Falls,  S.  D. 

Vice-President C.  S.  Larson,  M.D.,  Sioux  Falls,  S.  D. 

Secretary A.  K.  Myrabo,  M.D.,  Sioux  Falls,  S.  D. 

Treasurer D.  L.  Ensberg,  M.D.,  Sioux  Falls,  S.  D. 


DISTRICT  8 

D.  Reaney,  M.D.,  Yankton,  S.  D. 

R.  Monk,  M.D.,  Yankton,  S.  D. 

A.  C.  Michael,  M.D.,  VermiUion,  S.  D. 
W.  Stanage,  M.D.,  Yankton,  S.  D. 


DISTRICT  9 

President ...  S.  F.  Sherrill,  M.D.,  Belle  Fourche,  S.  D.  '] 

Vice-President R.  Boyce,  M.D.,  Rapid  City,  S.  D.  I 

Secretary-Treasurer..... Wayne  Geib,  M.D.,  Rapid  City,  S.  D.  ) 


DISTRICT  10 

President F.  J.  Clark,  M.D.,  Gregory,  S.  D.  I 

Secretary-Treasurer  Peter  Lakstigala,  M.D.,  White  River,  S.  D.  | 


DISTRICT  11  ! 

Secretary-Treasurer B.  P.  Nolan,  M.D.,  Mobridge,  S.  D.  9 


DISTRICT  12  I 

President E.  A.  Johnson,  M.D.,  Milbank,  S.  D.  I 

Vice-President- ...W,  H.  Karlins,  M.D.,  Webster,  S.  D.  . 

Secretary-Treasurer Dagfin  Lie,  M.D.,  Webster,  S.  D. 


President 

Vice-President 

Secretary 

Treasurer 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


33 


CLINICAL 

COLLOQUY 


My  patients  complain  that 
the  pain  tablets  I prescribe 
are  too  slow-acting . . . 
they  usually  take  about 
30  to  JfO  minutes  to  work. 

Why  don't  you  try 
the  new  analgesic 
that  gives  faster, 
longer- lasting  pain  relief? 

What  is  it... 
how  fast  does  it  act? 

It's  Percodan*— relieves  pain 
in  5 to  15  minutes, 
with  a single  dose 
lasting  6 hours  or  longer. 

How  about  side  effects? 

No  problem.  For  example, 
the  incidence  of  constipation 
with  Percodan*  is  rare. 

Sounds  worth  trying  — 
whafs  the  average  adult  dose? 

One  tablet  every  6 hours. 

That's  all. 

Where  can  I get 
literature  on  Percodan? 

Just  ask  your  Endo  detailman 
or  write  to: 


ENDO  LABORATORIES 

Richmond  Hill  18,  New  York 


*U.  S.  Pat.  2,628,185.  PERCODAN  contains  salts  of  dihydrohydroxycodeinone  and 
homatropine,  plus  APC.  May  be  habit-forming.  Available  through  all  pharmacies. 


34 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


respiratory  congestion 


reiiet  in  minutes.. iasts  tor 


orally 

hours 


In  the  common  cold,  nasal  allergies,  sinus- 
itis, and  postnasal  drip,  one  timed-release 
Triaminic  tablet  brings  welcome  relief  of 
symptoms  in  minutes.  Running  noses  stop, 
clogged  noses  open — and  stay  open  for  6 to 
8 hours.  The  patient  can  breathe  again. 

With  topical  decongestants,  “unfortu- 
nately, the  period  of  decongestion  is  often 
followed  by  a phase  of  secondary  reaction 
during  which  the  congestion  may  be  equal 
to,  if  not  greater  than,  the  original  condi- 
tion. . . The  patient  then  must  reapply 
the  medication  and  the  vicious  cycle  is 
repeated,  resulting  in  local  overtreatment, 
pathological  changes  in  nasal  mucosa,  and 
frequently  “nose  drop  addiction.” 

Triaminic  does  not  cause  secondary  con- 
gestion, eliminates  local  overtreatment  and 
consequent  nasal  pathology. 

'Morrison,  L.  F.:  Arch.  Otolaryng.  S9:48-53  (Jan.)  1954. 

Each  double-dose  “timed-release"  triaminic 
Tablet  contains: 

Phenylpropanolamine  hydrochloride  50  mg. 

Pyrilamine  maleate 25  mg. 

Pheniramine  maleate 25  mg. 

Dosages  1 tablet  in  the  morning,  afternoon,  and 
in  the  evening  if  needed. 


Each  double-dose  *‘timed-release’^ 
tablet  keeps  nasal  passages 
clear  for  6 to  8 hours — 
provides  **around-the-clocJd* 
freedom  from  congestion  on 
just  three  tablets  a day 


disintegrates  to  give  3 to  4 
more  hours  of  relief 


Also  availables  Triaminic  Syrup,  for  children  and 
those  adults  who  prefer  a liquid  medication. 


A 


Triaminic 


timed- release” 
tablets 


\ running  noses . . . and  open  stuffed  noses  orally 

SMITH-DORSEY  • a division  of  The  Wander  Company  • Lincoln,  Nebraska  • Peterborough.  Canada 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


35 


} . .«aRd  for  a nutritional  buildup 
I plus  freedom  from  leg  cramps* 

STORCAVITE* 


BONADOXIN  brings  relief  to  88.1% 
of  patients ...  often  within  a few  hours.'-^ 
But  it  does  not  produce  drowsiness,  or 
side  effects  associated  with  over-potent 
antinauseants.  With  safe  BONADOXIN, 
“toxicity  and  intolerance . . . [is]  zero.”2 

Is  she  blue  at  breakfast?  Prescribe 
BONADOXIN.  Usually  just  one  tablet  at 
bedtime  stops  nausea  and  vomiting 
of  pregnancy ... 


IT  DOESN’T  STOP  THE 


PATIENT 


BONADOXIN^ 

STOPS  MORNING  SICKNESS ...  BUT 


phosphatMree  calcium,  10  essential 
vitamins,  8 Important  minerals. 
Bottles  of  100. 


I 


NEW  YORK  17,  NEW  YORK 
Division,  Chas.  Pfizer  & Co.,  Inc. 


and  just  one  supplies  the  a 

full  50  mg.  of  pyridoxine.  Sf~~ 
EACH  TABLET  CONTAINS: 

MECLIZINE  HCI 25  mg. 

PYRIDOXINE  HCI SO  mg. 

Bottles  of  25  and  100. 

References:  1.  Groskloss,  H.  H.,  et  al:  Clin. 
Med.  ^:885  (Sept.)  1955.  2.  Goldsmith,  J.  W.: 
Minnesota  Med.  40:99  (Feb.)  1957. 


36 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


TETRACYCLINE-ANTIHISTAMINE-ANALGESIC  COMPOUND  LEDERLE 


A versatile,  well-balanced  formula  capable  of  modifying 
the  course  of  common  upper  respiratory  infections  . . . 
particularly  valuable  during  respiratory  epidemics;  when 
bacterial  complications  are  likely;  when  patient’s  history 
is  positive  for  recurrent  otitis,  pulmonary,  nephritic,  or 
rheumatic  involvement. 

Adult  dosage  for  Achrocidin  Tablets  and  new  calTeine- 
free  Achrocidin  Syrup  is  two  tablets  or  teaspoonfuls  of 
syrup  three  or  four  times  daily.  Dosage  for  children  ac- 
cording to  weight  and  age. 

Available  on  prescription  only. 


TABLETS  (sugar  coated)  Each  Tablet  contains: 


Achromycin®  Tetracycline  125  mg. 

Phenacetin 120  mg. 

Caffeine 30  mg. 

Salicylamide  150  mg. 

Chlorothen  Citrate 25  mg. 

Bottles  of  24  and  100. 


SYRUP  (lemon  -lime  flavored)  Each  teaspoonful  (5  cc.) 


contains: 

Achromycin®  Tetracycline 

equivalent  to  tetracycline  HCl 125  mg. 

Phenacetin  120  mg. 

Salicylamide  150  mg. 

Ascorbic  Acid  (C)  25  mg. 

Pyrilamine  Maleate  15  mg. 

Methylparaben  4 mg. 

Propylparaben  1 mg. 

Bottle  of  4 oz. 


malaise 

chilly  sensations 
low-grade  fever 
headache 
muscular  pains 
pharyngeal  and  nasal 
discharge  :■ 


rapidly  relieves 


debilitating  symptoms 


LEDERLE  LABORATORIES 
♦Trademark 


PEARL  RIVER.  NEW  YORK 


DIVISION. 


AMERICAN  CYANAMID  COMPANY. 


FEBRUARY  1958 


37 


of  infant  feeding 

Standard  formulas  for  NEWBORNS 

Breast  feeding  is  the  procedure  of  choice  for 
the  newborn.  But  it  may  need  to  be  comple- 
mented with  standard  formulas  given  here. 

The  first  feeding,  12  hours  after  birth,  consists 
of  a prelacteal  solution  of  5%  Karo  Syrup,  one 
or  two  ounces,  repeated  at  two-hour  intervals. 
Breast  feeding  is  started  on  the  second  day  for 
five-minute  intervals  and  the  prelacteal  feed- 
ing continued  immediately  thereafter  and 
between  nursings. 

Formula  feeding  is  given  on  the  second  day  if 
breast  feeding  is  denied.  The  small  infant 
prefers  the  three-hour  schedule  and  the  large 
infant  the  four-hour  schedule. 

The  initial  formula  is  a low-caloric  milk  mix- 
ture, gradually  increased  in  r^ncentration 
over  several  day  intervals  accoruing  to  toler- 
ance. Standard  formulas  for  whole  cow’s  milk 
or  evaporated  milk  modified  with  diluted 
Karo  Syrup  as  shown  here,  constitute  the 
dietary  regimen  for  well  newljorns. 

First  formulas  for  newborns, 

concentrated  according  to  tolerance 
Evaporated  Milk  Formulas:  3 oz.  q 4h  x 6 feedings 

FORMULA  I FORMULA  II  FORMULA  III 

12.5  cals./oz.  16  cals./oz,  20  cals./oz. 


Evap.  Milk  . . 4 oz  5 oz.  6 oz. 

Water 14  oz.  13  oz.  12  oz. 

Karo  Syrup  . . 1/2  oz.  3/4  oz.  1 oz. 


Whole  Cow's  Milk  Formulas:  3 1/2  oz.  q 4h  x 6 feedings 


FORMULA  I 
11  cals./oz. 


FORMULA  II 
11.5  cals./oz. 


FORMULA  ill 
13.5  cals./oz. 


Whole  Milk  . . 8 oz.  9 oz. 

Water 12  oz.  11  oz. 

Karo  Syrup  . . 1/2  oz.  3/4  oz. 


10  oz. 
10  oz. 
1 oz. 


ADVANTAGES  OF  KARO  IN  INFANT  FEEDING 


CoiTipOS'ltiOTl’  Karo  is  a su- 
perior maltose-dextrin  mixture 
because  the  dextrins  are  non-fer- 
mentable  and  the  maltose  is 
rapidly  transformed  into  dextrose 
which  requires  no  digestion. 

CoTlCCfltTO/ti/OTl’  Volume  for 
volume  Karo  furnishes  twice  as 
many  calories  as  similar  milk 
modifiers  in  powdered  form. 

Puvity’  Karo  is  processed  at 
sterilizing  temperatures,  sealed 
for  complete  hygienic  protection 
and  devoid  of  pathogenic  or- 
ganisms. 

Low  Cost’  Karo  costs  l/5th  as 
much  as  expensive  milk  modifiers 
and  is  available  at  all  food  stores. 


Medical  Division 

CORN  PRODUCTS  REFINING  COMPANY 

1 7'  Battery  Place,  New  York  4,  N.  Y. 


A 


38 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


DRINK 


The  purity,  the 
wholesomeness, 
the  quality  of 
Coca-Cola  as 


refreshment  has  helped 


make  Coke  the 


best-loved  sparkling 
drink  in  alt  the  world. 


SIGN  OF  GOOD  TASTE 


i fcdnn 

Aspirin  200  mg.  (3  grains)  i q.  n tabiefs 

Phenacetin  ISO  mg.  (2V2  grains)  ' ° laoieis. 

Potentiated  Pain  Reiief 

WINTHROP  LABORATORiiS 

New  York  18,  N.  Y.  • Windsor,  Ont. 

Demerol  (brand  of  meperidine), 
trademark  reg.  U.S.  Pat.  Off. 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


39 


AN  AMES  CLINIQUICK 

CLINICAL  BRIEFS  FOR  MODERN  PRACTICE 


‘EMPTYING”  OF  GALLBLADDER  AFTER  FATTY  MEAL^ 


5 egg  yolks 


a 24  48  72  96  120 

Minutes 

Adapted  from  Wright,  S.;  Applied  Physiology,  ed.  8,  London, 
Oxford  University  Press,  1947,  p.  734. 


W' 


mm 


Whafs  wrong  with  the  term 

“emptying  of  the  gallbladder”? 

The  gallbladder  discharges  bile  by  fractional  evacuation.  It  is  not 
emptied  completely  at  any  one  time  even  following  a fatty  meal. 

Sowrce  — Lichtman,  S.  S.:  Diseases  of  the  Liver,  Gallbladder  and  Bile  Ducts,  ed.  3, 
Philadelphia,  Lea  & Febiger,  1953,  vol.  2,  p.  1177. 


■ 


routine  physiologic  support  for  “sluggish”  older  patients 
DEOHOLir  one  tablet  t.i.d. 

therapeutic  bile 

increases  bile  flow  and  gallbladder  function— comhzis  bile  stasis 
and  concentration . . . helps  thin  gallbladder  contents. 

corrects  constipation  without  catharsis— pxevtnis  colonic  dehydra- 
tion and  hard  stools . . . provides  effective  physiologic  stimulant. 

Decholin  tablets  (dehydrocholic  acid,  Ames)  3%  gr.  Bottles  of  100  and  500. 


AMES  COMPANY,  INC  • ELKHART,  INDIANA 
Ames  Company  of  Canada,  Ltd.,  Toronto  44656 


■*. 


m 


k\ 


40 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


in  v«ry  special  cases 
a very  superior  brandy...  ^ 


mmmmmssY 

COGNAC  BRANDY 

84  Proof  ! Schieftelin  & Co.,  New  York 


I 


« 


Protection  against  loss  of  income  from  acci- 
dent & sickness  as  well  as  hospital  expense 
benefits  for  you  and  all  your  eligible  depend- 
ents. 


PHYSICIANS  CASUALTY  & HEALTH 
ASSOCIATIONS 

OMAHA  31,  NEBRASKA 
SINCE  1902 


PERF^ORMANCe  WITH 


GREATER  PERMANENCE 
IN  THE  MANAGEMENT 
OF  DERMATOSES... 

(Regardless  of  Previous  Refractoriness) 

Confirmed  by 
an  impressive  and 
growing  body  of  published 
clinical  investigations 


A'y  JLC  4k  A)l  ointment 

Hytlrocortisone  0.5%,  Nebrfiycln  0.35%  <as  Sulfate)  and  Special 
Coal  Tar  Extract  5%  (TARBONIS)  in  an  orntment  base. 


REED  A CARNRICK 


y Jersey  City  6,  New  Jersey 


* 


1.  Clyman.  S.  G. : Postgrad.  Med.  2t  :309,  19B7. 

2.  Bleiberg.  J.:  J.  M.  Soc.  New  Jersey  5S:37,  1956. 

3.  Abrams.  B.  E.  and  Sbaw,  C. : Clin.  Med.  J:839,  1966... 

4.  Welsh.  A.  L.,  and  Ede,  M. : Ohio  State  M.  J.  SO : 837.  1964. 
6.  Bleiberg,  J.:  Am.  Practitioner  8:1404,  1957. 


New... from  Rizer  Research 


compounds  tested 


compound  unexcelled 


Progress  has  been  made  in  antibiotic  therapy 
through  the  use  of  absorption-enhancing  agents, 
resulting  in  higher,  more  effective  antibiotic  blood 
levels. 

For  the  past  two  years,  in  a continuing  search 
for  more  effective  agents  for  enhancing  oral  anti- 
biotic blood  levels,  our  Research  Laboratories 
screened  eighty-four  adjuvants,  including  sorbitol, 
citric  acid,  sodium  hexametaphosphate,  and  other 
organic  acids  and  chelating  agents  as  well  as  phos- 
phate complex  and  other  analogs.  After  months  of 
intensive  comparative  testing,  glucosamine  proved 
to  be  the  absorption-enhancing  agent  of  choice. 
Here’s  why ; 

1 Crossover  tests  show  that  average  blood  levels 
achieved  with  glucosamine  were  markedly  higher 
than  those  of  other  enhancing  agents  screened.  In 
some  cases  this  effect  was  more  than  double. 

2 Of  great  importance  to  the  practicing  physi- 
cian is  the  consistency  of  the  blood  level  enhance- 
ment achieved  with  glucosamine.  Extensive  tests 
show  that  the  enhancing  effect  with  glucosamine 
occurs  in  a greater  percentage  of  cases  than  with 
any  other  agent  screened. 

3 Glucosamine  is  a nontoxic  physiologic  metabo- 
lite occurring  naturally  and  widely  in  human  se- 
cretions, tissues  and  organs.  It  is  nonirritating  to 
the  stomach,  does  not  increase  gastric  secretion, 
is  sodium  free  and  releases  only  four  calories  of 
energy  per  gram.  Also,  there  is  evidence  that  glu- 
cosamine may  favorably  influence  the  bacterial 
flora  of  the  intestinal  tract. 

For  these  reasons  glucosamine  provides  you  with 
an  important  new  adjuvant  for  better  enhance- 
ment of  antibiotic  blood  levels.  Tetracycline,  po- 
tentiated physiologically  with  glucosamine,  is  now 
available  to  you  as  Cosa-Tetracyn. 

Capsules  250  mg.  and  125  mg. 


COSA-TETRACYN 

glucosamine-potentiated  tetracycline 

The  most  widely  used 
broad-spectrum  antibiotic 
now  potentiated  with 
glucosamine, the 

Pfizer  Laboratories  enhancing  agent  of  choice 

Kjrfizer)  Division,  Chas.  Pfizer  &.  Co.,  Inc, 

— ^ Brooklyn  6,  N.  Y. 


'Trademark 


42 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


Advertisers — February,  1958 

Abbott  Laboratories 

Ames  Company 

Ayerst  Laboratories 

Brown  Drug 

Coca  Cola  Company 

Corn  Products  Sales  Company 

Burroughs-Welcome 

Druggists’  Mutual  Insurance  Co. 

Endo  Laboratories 
General  Electric 
Kreiser’s  Inc. 

Lakeside  Laboratories 
Lederle  Laboratories 
Eli  Lilly  & Co. 

Merck,  Sharp  & Dohme 
Midwest-Beach 
Parke,  Davis  & Co. 

Pfizer  Laboratories 
Physicians  Casualty  Assn. 

Reed  & Carnrick 
Riker  Laboratories 
A.  H.  Robins 
J.  B.  Roerig  & Co. 

Schering  Corporation 
Schieffelin  & Co. 

G.  D.  Searle  & Co. 

Smith-Dorsey  Co. 

Smith,  Kline  & French  Labs 
E.  R.  Squibb  & Sons 
U.  S.  Brewers  Fouhdation 
Upjohn  Company 
Wallace  Laboratories 
Winthrop  Laboratories 
Wyeth,  Inc. 


EVERY  WOMAN 
WHO  SUFFERS 
IN  THE 
MENOPAUSE 
DESERVES 

"premarin: 

widely  used 
natural,  oral 
estrogen 


AYERST  LABORATORiES 
New  York,  N.  Y.  • Montreal,  Canada 
6646 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


the  chill 

the  cough 


the  aching  muscles 

the  fever 


Viral  upper  respiratory  infection. . . . For  this  patient,  your  management  will  be  twofold — 
prompt  symptomatic  relief  plus  the  prevention  and  treatment  of  bacterial  complications. 
PEN*VEE*Cidiin  backs  your  attack  by  broad,  multiple  action.  It  relieves  aches  and  pains,  and 
reduces  fever.  It  counters  depression  and  fatigue.  It  alleviates  cough.  It  calms  the  emotional 
unrest.  And  it  dependably  combats  bacterial  invasion  because  it  is  the  only  preparation  of  its 
kind  to  contain  penicillin  V. 

SUPPLIED:  Capsules,  bottles  of  36.  Each  capsule  contains  62.5  mg.  (100,000  units)  of  penicillin  V,  194  mg.  of 
salicylamide,  6.25  mg.  of  promethazine  hydrochloride,  130  mg.  of  phenacetin,  and  3 mg.  of  mephentermine  sulfate. 

Pen-Vee-^&  . 

Penicillin  V with  Salicylamide,  Promethazine  Hydrochloride.  Phenacetin,  and  Mephentermine  Sulfate,  Wyeth  Philadelphia  1,  Pa. 


This  advertisement  con- 
forms to  the  Code  for 
Advertising  of  the  Physi- 
cians' Council  for  Infor- 
mation on  Child  Health. 


44 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


Your  one-stop  direct  source  for  the 

FINEST  IN  X-RAY 

apparatus . . . service . . . supplies 


DIRECT  FACTORY  BRANCHES 

MINNEAPOLIS 

808  Nicollet  Ave.  • FEderal  6-1643 
OMAHA 

1617  Dodge  St.  • ATlantic  6049 


RESIDENT  REPRESENTATIVE 

SIOUX  FALLS 
A.  G.  TROSTAD 

2501  S.  Baluvelt  Ave.  • Phone  2-3066 


PRESCRIPTION  SPECIALTY: 
SIGNEMYCIN  SYRUP 

WHAT  THE  PRODUCT  IS:  Tetracycline  and 
triacetyloleandomycin  in  an  homogenized  red 
colored,  raspberry  flavored  ready-mix  syrup. 
WHAT  IT’S  FOR:  Treatment  of  a wide  range 
of  microbial  infections  caused  by  both  Gram 
negative  bacteria,  with  added  protection 
against  resistant  staphylococci. 

ITS  ADVANTAGES;  Especially  formulated 
for  pediatric  patients  or  those  patients  who 


cannot  or  will  not  take  solid  forms  of  med- 
ication. 

HOW  ADMINISTERED:  Orally,  as  pres- 
cribed by  the  physician.  Each  teaspoonful 
(5  cc.)  contains  125  mg.  Stignemycin  activity 
(42  mg.  oleandomycin  as  triacetyloleando- 
mycin, and  tetracycline  equivalent  to  83  mg. 
tetracycline  hydrochloride). 

HOW  IT’S  SOLD:  2 oz.  and  1 pint  bottles. 
WHO  MAKES  IT:  Pfizer  Laboratories,  di- 
vision of  Chas.  Pfizer  & Co.,  Inc.  630  Flushing 
Avenue,  Brooklyn,  N.  Y.  ' 


PRESTIGE 

PRESCRIPTION 

PRODUCTS 


Now,  more  than 
at  any  other 
time 

of  the  year . . . 


WE  ARE  A 


you  need 
a double  check! 

This  is  the  peak  season  for  respiratory  infections,  and 
now  that  the  holiday  merchandising  rush  and  year-end 
inventory  are  past,  a realistic  check  on  R department 
stocks  is  vital. 

Ask  our  salesman  to  help  you  accomplish  this  task.  Then 
replenish  your  needs  from  our  complete,  comprehensive 
stock  with  a minimum  of  delay  and  confusion.  For  really 
competent  service,  send  your  orders  to  us. 

BROWN  DRUG  COMPANY 


DISTRIBUTOR 


SIOUX  FALLS,  SOUTH  DAKOTA 


S.D.J.O.M.  FEBRUARY  1958  - ADV. 


45 


for  ''This  Wormy  World 


Pleasant  tasting 

‘ANTEPAR! 


brand 


PIPERAZINE 


SYRUP  • TABLETS  • WAFERS 

Eliminate  PINWORMS  IN  ONE  WEEK 
ROUNDWORMS  IN  ONE  OR  TWO  DAYS 


• ECONOMICAL 


ANTEPAR^  SYRUP  < Piperazine  Citrate,  100  mg.  per  ec. 
^ANTEPAR’  TABLETS  -Piperazine  Citrate,  250  or  500  mg.,  seored 
ANTEPAR*  WAFERS  - Piperazine  Phospliate,  500  rag. 

Literature  avuilahle  on  request 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  Tuckahoe,  N.  Y. 


FROM  INFECTION-  FROM  IRRITATION 


RELIEF 


^as  adjunctive  therapy  only 


THE  FIRST  TROCHE  TO  PROVlOE 


THREEFOLO  OENEFITS 


PENTAZETS 


I 


TROCHES 


NON-NARCOTIC  ANTITOSSIVE  EFFICACY 
SHOWN  TO  APPROXIMATE  THAT  OF  COOEINE 


With  the  addition  of  a non-narcotic  antitussive 
to  troche  medication,  ‘Pentazets’  provides 
a new  and  extended  therapeutic  advantage  in 
this  convenient  form  of  treatment. 

Treatment  of  the  cough  too,  so  often  a 
troublesome  symptom  of  sore  throat,  combined 
with  wide-range  antibiotic  activity  and 
soothing  analgesic  benefit,  now  offers  threefold 
relief  in  a variety  of  throat  irritations. 

And  ‘Pentazets’  are  pleasant-tasting,  too, 
making  them  highly  acceptable,  especially 
to  children. 

‘PENTAZETS*  contains: 

• Homarylamine—a  new  non-narcotic  antitussive  with  cough 
control  shown  to  approximate  that  of  codeine.  • Bacitracin- 
Tyrothricin-Neomycin  — a combined  antibiotic  treatment 
against  many  pathogenic  organisms  with  little  danger  of 
unfavorable  side  effects.  • Benzocaine—a  local  anesthetic  for 
soothing  relief  to  inflamed  tissues.  Being  slowly  absorbed, 
it  is  especially  beneficial  for  prolonged  effect  and  benefit  to 
surrounding  areas. 

Supplied:  Vials  of  12. 

Each  'PENTAZETS’  troche  contains: 

Homarylamine  hydrochloride  20  mg.  ■mm 

Zinc  Bacitracin 50  units  ^ 

Tyrothricin 1 mg.  ‘ \ 

Neomycin  sulfate  6 mg.  f 

(equivalent  to  3.5  mg.  neomycin  base)  JKB 

Benzocaine 5 mg. 

MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  & CO.,  Inc.,  PHIUDELPHIA  1,  PA. 


there’s  pain  and 
inflammation  here... 
it  could  be  mild 
or  severe,  acute  or 
chronic,  primary 
secondary  fibrositis- 

early  rheumatoid  arthriti 


f- 


more  potent  and  comprehensive  treatment 
than  salicylate  alone 

assured  anti-inflammatory  effect  of  low-dosage 
corticosteroid'  . . . additive  antirheumatic  action  of 
corticosteroid  plus  salicylate^'®  brings  rapid  pain 
relief;  aids  restoration  of  function  . . . wide  range 
of  application  including  the  entire  fibrositis  syn- 
drome as  well  as  early  or  mild  rheumatoid  arthritis 

more  conservative  and  manageable  than  full- 
dosage  corticosteroid  therapy- 

much  less  likelihood  of  treatment-interrupting 
side  effects'  * . . . reduces  possibility  of  residual 
injury  . . . simple,  flexible  dosage  schedule 


THERAPY  SHOULD  BE  INDIVIDUALIZED 
acute  conditions:  Two  or  three  tablets  four  times  daily.  After 
desired  response  is  obtained,  gradually  reduce  daily  dosage 
and  then  discontinue. 


subacute  or  chronic  conditions:  Initially  as  above.  When  sat- 
isfactory control  is  obtained,  gradually  reduce  the  daily 
dosage  to  minimum  effective  maintenance  level.  For  best 
results  administer  after  meals  and  at  bedtime. 

precautions:  Because  sigmagen  contains  prednisone,  the 
same  precautions  and  contraindications  observed  with  this 
steroid  apply  also  to  the  use  of  sigmagen. 


in 

any 
case 
calls  for 


tablets 

Composition 

METicoRTEN®  (prednisone)  0.75  mg. 

Acetylsalicylic  acid  325  mg. 

Aluminum  hydroxide  75  mg. 

Ascorbic  acid  20  mg. 

Packaging:  sigmagen  Tablets,  bottles  of  100  and  1000. 
References:  1.  Spies,  T.  D.,  et  al.:  J.A.M.A.  159:645, 
1955.  2.  Spies,  T.  D.,  et  al.;  Postgrad.  Med.  17:1,  1955. 
3.  Gelli,  G.,  and  Della  Santa,  L.:  Minerva  Pediat. 
7:1456,  1955.  4.  Guerra,  F.:  Fed.  Proc.  12:326,  1953. 
5.  Busse,  E.  A.:  Clin.  Med.  2:1105,  1955.  6.  Sticker. 
R.  B.:  Panel  Discussion.  Ohio  State  M.  J.  52:1037, 1956. 


50 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


BUY 

An  old  adage  says  "Clothes  make  the  man."  Per- 
haps this  is  not  true  in  a very  strict  sense,  but 
nevertheless  a well-groomed  man  makes  a better 

QUALITY 

impression  than  one  who  is  not.  This  same  reason- 
ing may  well  apply  to  the  printed  forms  which 
leave  your  office.  A dignified,  well-printed  state- 

IN  YOUR 

ment  or  envelope  can  lend  a great  deal  of  prestige 
to  your  practice.  It  costs  no  more  to  get  QUALITY 
printing  than  poor  printing. 

PRINTING 

We've  had  many  years  of  printing  experience  and 
would  like  to  help  you  with  your  printing  require- 
ments. 

MIDWEST-BEACH  COMPANY 

222  South  Phillips  Ave. 

• Sioux  Falls,  S.  Dak. 

^ Both 


IPHERAL 


ANTITUSSIVE  . DECONGESTANT  • A N T I H I ST A M I N 1 C 


Cowhum : 


LABORATORIES 


NEW  YORK  18,  N.  Y 


(4cc.]  cMtms 


EXEMPT  NARCOTIC 


n6W  for  angina 


In  pain.  Anxious.  Fearful.  On  the  road  to  cardiac 
invalidism.  These  are  the  pathways  of 
angina  patients.  For  fear  and  pain  are  inexorably 
linked  in  the  angina  syndrome. 

For  angina  patients— perhaps,  the  next  one  who 
enters  your  office— won’t  you  consider  new 
CARTRAX?  This  doubly  effective  therapy  combines 
PETN  (pentaerythritol  tetranitrate)  for  lasting 
vasodilation  and  atarax  for  peace  of  mind. 

Thus  CARTRAx  relieves  not  only  the  anginal  pain 
but  reduces  the  concomitant  anxiety. 


New  York  17,  New  York 


Division,  Chas.  Pfizer  & Co.,  Inc. 


Dosage  and  supplied:  begin  with  1 to  2 yellow  cartrax 
"10”  tablets  (10  mg.  petn  plus  10  mg.  atarax)  3 to  4 times 
daily.  When  indicated,  this  may  be  increased  for  more 
optima!  effect  by  switching  to  pink  cartrax  “20”  tablets 
(20  mg.  PETN  plus  10  mg.  atarax.)  For  convenience,  write 
“CARTRAX  10”  or  "cartrax  26.”  In  bottles  of  100. 

CARTRAX  should  be  taken  30  to  60  minutes  before  meals,  on 
a continuous  dosage  schedule.  Use  petn  preparations 
with  caution  in  glaucoma, 

‘"Cardiac  patients  who  show  significant  manifestations  of 
anxiety  should  receive  ataractic  treatment  as  part  of  the 
therapeutic  approach  to  the  cardiac  problem.*’^ 

1.  WaWman,  S.,  and  Pelner,  L.:  Am.  Pract.  & Digest  Treat.  S:1075  (July)  1957. 
•trademark 


52 


S.DJ.O.M.  FEBRUARY  1958  - ADV. 


FROM  THE  GRAY  FLANNELS— 

Booklets  by  two  noted  authors,  first  on  a 
unique  series  designed  to  help  parents  of 
crippled  children,  but  equally  applicable  to 
those  of  children  who  are  not  handicapped, 
have  just  been  published  by  the  National 
Society  for  Crippled  Children  and  Adults. 

In  one,  Earl  Miers,  prominent  author,  editor 
and  Civil  War  authority,  has  written  his  own 
story  of  conquest  of  cerebral  palsy  in  “Why 
Did  This  Have  to  Happen?”  Dr.  Grace  Lang- 
don,  one  of  the  country’s  well-known  leaders 


in  the  field  of  child  development  and  special- 
ist in  the  relation  of  toys  to  every  day  living, 
has  written  the  second,  “Your  Child’s  Play.” 

To  assist  in  solving  the  perplexing  problems 
which  confront  parents  in  raising  handi- 
capped children,  Mr.  Miers  offers  inspiration 
and  Dr.  Langdon,  practical  advice  to  all  par- 
ents, for  use  in  the  day-by-day  relationships 
with  their  children. 


Edward  Zink,  retired  sales  manager  of  Eli 
Lilly  and  Company,  died  January  17  at  the 
age  of  eighty.  Caused  by  a pulmonary  fi- 
brosis, death  took  place  at  his 
home  in  Indianapolis. 

Mr.  Zink’s  death  ended  an 
association  of  sixty  years 
with  Eli  Lilly  and  Company. 
He  joined  the  firm  Septem- 
ber 1,  1897;  and  held  the 
position  of  plant  superintend- 
ent before  transferring  to 
sales  work.  Among  other 
sales  assignments,  he  served 
Lilly  as  a representative  in 
Wisconsin  and  was  the  first 
manager  of  the  eastern  di- 
vision before  being  named 
sales  manager.  Following  his 
retirement  on  January  1, 
1943,  he  continued  to  be  con- 
sulted by  the  company  on 
matters  of  sales  administra- 
tion. 

A native  of  Missouri,  “Ned” 
Zink  was  born  September 
10,  1877,  in  Houstonia.  He 
attended  DePauw  Univer- 
sity. 

Mr.  Zink’s  wife  preceded 
him  in  death  in  1955.  The 
only  survivor  is  a nephew, 
James  E.  Zink,  manager  of 
Lilly’s  equipment  and  sup- 
plies purchases  department. 


r”  ' 

ft  vour  ft"^*  i 

souftc  tof 


t the  ins«u«"ent  - 1 1 s 

"“'"‘’'ruT'ovedSg 

)n  withou  ji^eostat 

ips  last  longer. 


^ 6'  eoHed  ***■  * { without 

„,.j_  connects  to 
;:"CUM20V.AC, 

$60-0® 

No.  


KREISER  SURGICAL  Inc. 


Sioux  Falls,  S.  D. 
1220  S.  Minnesota 


Rapid  City,  S.  D. 
528  Kansas  City  St. 


Alseroxylon  less  toxic  than  reserpine 

“...alseroxylon  is  an  antihypertensive  agent 
of  equal  therapeutic  efficacy  to  reserpine  in 
the  treatment  of  hypertension,  but  with 
significantly  less  toxicity.” 

Ford,  R.V.,  and  Moyer,  J.H.:  Rauwolfia  Toxicity 
in  the  Treatment  of  Hypertension:  Some  Observa- 
tions on  Comparative  Toxicity  of  Reserpine,  a 
Single  Alkaloid,  and  Alseroxylon,  a Compound  Con- 
taining Multiple  Alkaloids,  Postgrad.  Med,,  Janu- 
ary, 1958. 


just  two  tablets 
at  bedtime 


Rauwiloid® 

(alseroxylon,  2 mg.) 

for  gratifying 

rauwolfia  response 

virtually  free  from  side  actions 


When  more  potent  drugs  are  needed,  prescnbe 

-.t  Rauwiloid®  d‘'  Veriloid® 

alseroxylon  1 mg,  and  oikovervir  3 mg* 

for  moderate  to  severe  hypertension. 

Initial  dose  1 tablet  t.i.d.,  p.c. 

Rauwiloid®  + Hexamethonium 

> alseroxylon  t mg.  end  hexamelhontum  chloride  dthydrote  250  mg. 

in  severe,  otherwise  intractable  hypertension. 

Initial  dose  V%  tablet  q.i.d. 

Both  combinations  in  convenient  single-tablet  form. 


To  prevent  emotional  upsets  in  cardiovascular  conditions 


Compazine 


the  tranquilizing  agent  remarkable 
for  its  freedom  from  drowsiness  and 
depressing  effect 

Available:  Tablets,  Ampuls,  Multiple  dose 
vials,  Spansule®  sustained  release  capsules. 
Syrup  and  Suppositories. 


‘Compazine’,  by  controlling  anxiety  and 
tension,  can  prevent  the  emotional  upsets 
that  so  often  play  an  exacerbating  role 
in  cardiovascular  conditions. 

And,  ‘Compazine’  can  be  depended  upon 
to  have  little,  if  any,  hypotensive  effect. 


Smith  Kline  & French  Laboratories,  Philadelphia 


★T.M.  Reg.  U.S.  Pat.  Off.  for  prochlorperazine,  S.K.F. 


MARCH  ^ 1958 


SPECIFICALLY 


for  petit  mal 

and  psychomotor  seizures 


KAPSEALS “ 

CELONTIN 


METHSUXIMIDE* 
0.3  GRAM 

Caution— Federal  law 
prohibits  dispensing 
without  prescription. 

U.S.  PaUnt  WtmT 
•5-cn»!hjt-»Iph».  alpha- 
fBc(b}lph<n;laacdDlaIda 


PARKi.  DAVIS.  & C0« 


CELONTIN  KAPSEALS 


(methsuximide,  Parke-Davis) 


Clinical  experience^-^’^  indicates  that  CELONTIN: 

• provides  effective  control  with  minimal  side  effects  in  the  treatment  of 
petit  mal  and  psychomotor  epilepsy; 

• frequently  checks  seizures  in  patients  refractory  to  other  medications; 

• has  not  been  observed  to  increase  incidence  or  severity  of  grand  mal 
attacks  in  patients  with  combined  petit  and  grand  mal  seizures. 
Optimal  dosage  of  CELONTIN  should  be  determined  by  individual 
needs  of  each  patient.  A suggested  dosage  schedule  is  one  0.3  Cm. 
Kapseal  daily  for  the  first  week.  If  required,  dosage  may  be  increased 
thereafter  at  weekly  intervals,  by  one  Kapseal  per  day  for  three  weeks, 
to  maximum  total  daily  dosage  of  four  Kapseals  (1.2  Cm.). 

1.  Zimmerman,  E T,  and  Burgemeister,  B.:  Arch.  Neurol,  ir  Psychiat.  72:720,  1954. 

2.  Zimmerman,  E T,  and  Burgemeister,  B.;  J.A.M.A.  157:1194,  1955. 

3.  Zimmerman,  E T.:  Arch.  Neurol.  6-  Psychiat.  76:65,  1956. 


the  Parke-Davis  family  of  anti-epileptics  provides  specificity 
and  flexibility  in  treatment  for  convulsive  disorders 


for  grand  mal  and  psychomofor  seizures 
DILANTIN*  Sodium  (diphenylhydantoin  sodium,  Parke-Davis)  is  supplied  in  a variety  of 
forms — including  Kapseals®  of  0.03  Gm.  and  of  0.1  Gm.  in  bottles  of  100 
and  1,000. 

PHELANTIN*  Kapseals  (Dilantin  100  mg.,  phenobarbital  30  mg.,  desoxyephedrine  hydro- 
chloride 2.5  mg.),  bottles  of  100. 

for  the  petit  mal  triad 

CELONTIN*  Kapseals  (methsuximide,  Parke-Davis),  0.3  Gm.,  bottles  of  100. 


MILONTIN*  Kapseals  (phensuximide,  Parke-Davis),  0.5  Gm.,  bottles  of  100  and  1,000. 
MILONTIN  Suspension,  250  mg.  per  4 cc.,  16-ounce  bottles. 


DETROIT  32.  MICHIGAN 


THE  SOUTH  DAKOTA 

JOURNAL  OF  MEDICINE 

AND 

PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


Volume  XI  March  1958  Number  3 


CONTENTS 


MEDICAL  SECTION 

Cesarean  Section  In  The  Country,  A Preliminary  Report 77 

Robert  H.  Hayes,  M.D.,  Winner,  South  Dakota 
H.  D.  Phelps,  Winner,  South  Dakota 

The  Diagnosis  And  Treatment  Of  Vaginal  Bleeding  During  Pregnancy  . . 83 
Leonard  P.  Heath,  M.D.,  Detroit,  Michigan 

Anesthesiology,  A Review 91 

President’s  Page 97 

M.  M.  Morrissey,  M.D.,  Pierre,  South  Dakota 

Editorial  Page 98 

Medical  Economics 100 

South  Dakota  State  Medical  Association  Council  Meeting 103 

Medical  Library  Bookshelf 105 

This  Is  Your  Medical  Association 108 

PHARMACY  SECTION 

Training  of  Pharmacists  Through  The  Practical  Experience  Approach  . .112 
Bliss  C.  Wilson,  Pierre,  South  Dakota 

Animal  Health  Pharmacy 114 

Kenneth  Redman,  Ph.D.,  Brookings,  South  Dakota 

The  Prescription  Pharmacist  Today 118 

Wallace  Croatman  and  Paul  B.  Sheatsley,  New  York  City,  New  York 

Editorial  Page 122 

President’s  Page 123 

George  Lehr,  Rapid  City,  South  Dakota 

Recent  Pharmaceutical  Specialties 124 

Pharmacy  News 126 


Entered  as  second-class  matter  January  22,  1948  at  the  post  office  at  Sioux  Falls,  South  Dakota 

under  the  act  of  August  24,  1912 

Published  monthly  by  the  South  Dakota  Medical  Association,  Publication  Office 
300  First  National  Bank  Building,  Sioux  Falls,  South  Dakota 


“Since  we’ve  had  him  on  NEOHYDRIN  he  can  walk 
without  dyspnea.  I wouldn’t  have  believed  it  possible 
a month  ago.” 


oral 

organomercurial 

diuretic 


TABLET  g 

NEOHYDRIN 


I 


LAKESIDE 


BRAND  OF  CHLORMERODRIN 


24658 


THE  SOUTH  DAKOTA 


JOURNAL  OF  MEDICINE 

AND 

PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


SUBSCRIPTION  $2.00  PER  YEAR 


SINGLE  COPY  20c 


Volume  XI 


March  1958 


Number  3 


STAFF 

Acting  Editor -Robert  E.  Van  Demark,  M.D. 

Assistant  Editor Patricia  Lynch  Saunders 

Associate  Editor  - — Harold  S.  Bailey,  Ph.D. 

Associate  Editor — D.  L.  Kegaries,  M.D. 

Associate  Editor — J.  A.  Nelson,  M.D 

Associate  Editor D.  H.  Manning,  M.D 

Business  Manager - -John  C.  Foster 


Sioux 

Falls, 

S. 

D. 

Sioux 

Falls, 

S. 

D. 

s. 

D. 

Rapid 

City, 

S. 

D. 

Sioux 

Falls, 

S. 

D. 

Sioux 

Falls, 

s. 

D. 

Sioux 

Falls, 

s. 

D. 

EDITORIAL  COMMITTEE 


G.  S.  Paulson,  M.D Rapid  City,  S. 

M.  L.  Spain,  M.D.  — Rapid  City,  S. 

H.  R.  Wold,  M.D Madison,  S. 

Mary  Price,  M.D. Armour,  S. 

Harold  Lowe,  M.D Mobridge,  S. 

A.  C.  Michael,  M.D — Vermillion,  S. 

T.  W.  ReuI,  M.D Watertown,  S. 

R.  E.  Van  Demark,  M.D Sioux  Falls,  S. 


D 

D 

D 

D 

D 

D 

D 

D 


PUBLICATIONS  COMMITTEE 

T.  H.  Saltier,  M.D.,  R.  E.  Van  Demark,  M.D.  and  the  Executive  Committee  of  The  South  Dakota 
Pharmaceutical  Association. 


OFFICERS 


South  Dakota  Pharmaceutical  Association 


D. 

D. 

Aherdeertr  S. 

D. 

Piftrre,  S. 

D. 

Fourth  Vice-President 

Parker,  S. 

D. 

J.  r.  ShirlAv 

D. 

Secretary 

-Bliss  C.  Wilson  

_ — Pierre.  S. 

D. 

South  Dakota  Stale  Medical  Association 


President 

Pre.sident  Elect 

Secretary -Treasurer 

Executive  Secretary 

Deleaate  to  A.M.A. 

Rapid  CitVf  S.  D. 

Chairman  Council 

Speaker  of  The  House 

r.  R Stolty,  M.n. 

Watertown,  S.  D. 

Sioux  Valley  Medical  Association 

Pre.sident 

Marion,  S.  D. 

Vice-President 

R P Carroll,  M.D. 

Laurel,  Nehr. 

Secretary 

Treasurer 

. -A.  K.  Mvrabo.  M.D 

. Sioux  Falls.  S.  D. 

S.DJ.O.M.  MARCH  1958  - ADV. 


5 


a superior  psychochemical 

for  the  management  of  both 
minor  and  major 

emotional  disturbances 


• more  effective  than  most  potent  tranquilizers 

• as  well  tolerated  as  the  milder  agents 

• consistent  in  effects  as  few  tranquilizers  are 


Dartal  is  a unique  development  of  Searle  Research, 
proved  under  everyday  conditions  of  office  practice 

It  is  a single  chemical  substance,  thoroughly  tested  and  found  particularly  suited 
in  the  management  of  a wide  range  of  conditions  including  psychotic,  psycho- 
neurotic and  psychosomatic  disturbances. 

Dartal  is  useful  whenever  the  physician  wants  to  ameliorate  psychic  agitation, 
whether  it  is  basic  or  secondary  to  a systemic  condition. 

In  extensive  clinical  trial  Dartal  caused  no  dangerous  toxic  reactions.  Drowsiness 
and  dizziness  were  the  principal  side  effects  reported  by  non-psychotic  patients, 
but  in  almost  all  instances  these  were  mild  and  caused  no  problem. 

Specifically,  the  usefulness  of  Dartal  has  been  established  in  psychoneuroses  with 
emotional  hyperactivity,  in  diseases  with  strong  psychic  overtones  such  as  ulcera- 
tive colitis,  peptic  ulcer  and  in  certain  frank  and  senile  psychoses. 

Usual  Dosage  • In  psychoneuroses  with  anxiety  and 
tension  states  one  5 mg.  tablet  t.i.d. 

• In  psychotic  conditions  one  10  mg.  tablet  t.i.d. 


Significant  J^^inslresearch  discovery: 


A NEW  SKELETAL 
MUSCLE  RELAXANT 


Robaxin  - synthesized  in  the  Robins  Research  Laboratories,  and 
intensively  studied  for  five  years— introduces  to  the  physician  an 
entirely  new  agent  for  effective  and  well-tolerated  skeletal  muscle 
relaxation.  Robaxin  is  an  entirely  new  chemical  formulation,  with 
outstanding  clinical  properties: 


• Highly  potent  and  long  acting. 

• Relatively  free  of  adverse  side  effects.’ 

• Does  not  reduce  normal  muscle  strength  or  reflex  activity 
in  ordinary  dosage.’^ 

• Beneficial  in  94.4%  of  cases  with  acute  back  pain 
due  to  muscle  spasm.’'®'^'®'^ 


CL.INICAL  RES  |f 


DISEASE  ENTITY 


Acute  back  pain  due 


(a)  Muscle  spasm  sect 
to  sprain 


(b)  Muscle  spasm  due) 
trauma 


(c)  Muscle  spasm  duel 
nerve  irritation  I 


(d)  Muscle  spasm  seerd 
to  discegenic  diseis 
and  postoperative! 
orthopedic  procedM 


Miscefloneous  (bursitil- 

torticollis,  etc.)  1 


TOTA 


(Methocarbamol  Robins,  U.S.  Pat.  No.  2770649) 


Highly  specific  action 

Robaxin  is  highly  specific  in  its  action  on  the 
intemuncial  neurons  of  the  spinal  cord  — with 
inherently  sustained  repression  of  multisyn- 
aptic  reflexes,  but  with  no  demonstrable  effect 
on  monosynaptic  reflexes.  It  thus  is  useful  in 
the  control  of  skeletal  muscle  spasm,  tremor  and 
other  manifestations  of  hyperactivity,  as  well 
as  the  pain  incident  to  spasm,  without  impair- 
ing strength  or  normal  neuromuscular  fimction. 


Beneficial  in  94.4%  of  cases  tested 

When  tested  in  72  patients  with  acute  back 
pain  involving  muscle  spasm,  Robaxin  in- 
duced marked  relief  in  59,  moderate  relief  in 
6,  and  slight  relief  in  3 — or  an  over-all  bene- 
ficial effect  in  94.4%.^’^'^’®’’^  No  side  effects 
occurred  in  64  of  the  patients,  and  only  slight 
side  effects  in  8.  In  studies  of  129  patients, 
moderate  or  negligible  side  effects  occurred 
in  only  6.2%.i’2-3-4.6,7 


I 


H ROBAXIN  IN  ACUTE  BACK  PAIN <■  a 7 


DURATION 

OF 

TREATMENT 

)OSE  PER  DAY  (divided) 

RESPONSE 
narked  mod.  slight 

neg. 

ilDE  EFFECTS 

2-42  days 

3-6  Gm. 

17 

1 

0 

0 

None,  16 

Dizziness,  1 

Slight  nausea,  1 

1-42  days 

2-6  Gm. 

8 

1 

3 

1 

None,  12 
Nervousness,  1 

4-240  days 

2.25-6  Gm. 

4 

1 

0 

0 

None,  5 

2-28  days 

1.5-9  Gm. 

24 

3 

0 

3 

None,  25 

Dizziness,  1 
Lightheaded- 
ness, 2 

Nausea,  2 * 

3-60  doys 

4-8  Gm. 

6 

0 

0 

0 

None,  6 

59 

6 

3 

4 

^Relifrved  on 
ro  JfKt'on 
of  dose 

^ ..  .‘Mef&'enceB:  l.  Carpenter,  E.  B.:  Publication  pendingr.  2.  Carter, 
•■t.,,  .C.  Hi:  Person^  cozonuinication:  3.  Forsyth,  EL  F.:  J^ublication 
pendinft  <f,  Freund,  J'  Personal  (ommunushon  S.  Mor^ui, 
A.  M.,  TruHt,  E,  B.,  Jr.,  and  Litllv.  .1.  M.:  American  Pharm.  Assn. 

6.  Nachman,  H.  M.:  Personal . commuiucation. 


Indications  — Acute  back  pain  associ* 
ated  with : (a)  muscle  spasm  secondary  to 
sprain;  (b)  muscle  spasm  due  to  trauma; 

(c)  mu.scTc  .spasm  due  to  nerve  irritation; 

(d)  muscle  spasm  secondary  to  discogenic 
disease  and  postoperative  orthopedic 
procedures;  and  miscellaneous  conditions, 
such  as  bursitis,  fibrositis,  torticollis,  etc. 


Dosage  — Adults:  Two  tablets  4 times 
daily  to  3 tablets  every  4 hours,  Ibtal  daily 
dosage:  4 to  9 Cm.  in  divided  doses. 


Precautions  — There  are  no  siiecific  con- 
traindications to  Robaxin  and  untoward 
reactions  are  not  to  be  anticipated  Minor 
side  effects  such  as  lightheadcdncs.s,  dizzi- 
ness, nausea  may  occur  rarely  in  patients 
with  unusual  sensitivity  to  drugs,  but  dis- 
appear on  reduction  of  dosage.  When  ther- 
apy is  prolonged  routine  white  blood  cell 
counts  should  be  made  since  some  decrease 
was  noted  in  3 patients  out  of  a group  of 
72  who  had  received  the  drug  for  periods 
of  30  days  or  longer.. 


Supply r-^ohsexin  Tablets,  0.5  Gm.,  in 
bottles  of  50. 


AH  Pnmwjtnn  iwn  Pirhmnndontf^ 


S.D.J.O.M.  MARCH  1958  - ADV. 


of  infant  feeding 

Standard  formulas  for  PREMATURES 

Breast  milk  is  satisfactory  for  the  feeding  of 
prematures  in  spite  of  the  low  protein  and 
mineral  and  high  fat  content.  But  eventual 
formula  feeding  should  provide  a high  protein 
and  carbohydrate  to  satisfy  the  rapid-growing 
needs  of  the  premature  and  low  fat  content 
because  of  limited  digestive  capacity. 

Feedings  of  small  prematures  are  most  effec- 
tively administered  by  the  indwelling  poly- 
thene nasal  catheter  and  of  large  prematures, 
by  bottle  with  small  nipples. 

The  first  six  feedings  should  be  a sterile  5% 
solution  of  Karo  Syrup  at  2 to  3 hour  intervals; 
for  subsequent  feedings,  breast  milk  or  for- 
mula should  be  added  in  gradually  increasing 
amounts  according  to  tolerance  and  require- 
ments, as  indicated  in  the  table  below. 


Initial  feeding  schedules 

for  premature  infants 

(Feedings  Started  After  36  Hours  and  Continued 


at  2 to  3 Hour  Intervals) 

FEEDINGS 

COMPOSITION 

QUANTITY 

First  Six 

5%  Karo 

2-5  ml. 

7th  and  8th 

2 parts  5%  Karo 

1 part  breast  milk 
or  formula 

6-10  ml. 

9th  and  10th 

1 part  5%  Karo 

1 part  breast  milk 
or  formula 

8-16  ml. 

nth  and  12th 

1 part  5%  Karo 

2 parts  breast  milk 
or  formula 

10-18  ml. 

Subsequently 

Breast  or  formula  feeding 

12-20  ml. 

ADVANTAGES 

OF  KARO®  IN  INFANT 

FEEDING 

Coifl'pOS'lt'lOn^  Karo  is  a su- 
perior maltose-dextrin  mixture 
because  the  dextrins  are  non-fer- 
mentable  and  the  maltose  is 
rapidly  transformed  into  dextrose 
which  requires  no  further  digestion. 

Concentration:  voi  ume  for 
volume  Karo  furnishes  twice  as 
many  calories  as  similar  milk 
modifiers  in  powdered  form. 

Purity:  Karo  is  processed  at 
sterilizing  temperatures,  sealed 
for  complete  hygienic  protection 
and  devoid  of  pathogenic  or- 
ganisms. 

Low  Cost:  Karo  costs  l/5th  as 
much  as  expensive  milk  modifiers 
and  is  available  at  all  food  stores. 


Medical  Division 

CORN  PRODUGTS  REFINING  COMPANY 
1 7 Battery  Place,  New  York  ^,N.Y. 


S.D.J.O.M.  MARCH  1958  - ADV. 


9 


REMARKABLE  EFFECTIVENESS  PLUS  A SAFETY  RECORD 
UNMATCHED  IN  SYSTEMIC  ANTIBIOTIC  THERAPY  TODAY 

Actually,  after  almost  six  years  of  extensive  use,  there  has  not  been  a single  report 
of  a serious  reaction  to  erythrocin.  And,  after  all  this  time,  the  incidence  of 
resistance  to  erythrocin  has  remained  exceptionally  low. 

You’ll  find  ERYTHROCIN  is  highly  effective  against  the  majority  of  coccal  infec- 
tions and  may  also  be  used  to  counteract  complications  from  Q Q ii 
severe  viral  attacks.  It  comes  in  Filmtabs  and  in  Oral  Suspension.  L>UjUXMX 


e020«9 


Compocillin-V 


for  those 

penicillin-sensitive 

organisms 


Indications 

Against  all  penicillin-sensitive 
organisms.  For  prophylaxis  and 
treatment  of  complications  in 
viral  conditions.  And  as  a prophy- 
laxis in  rheumatic  fever  and  in 
rheumatic  heart  disease. 

Dosage 

Depending  on  the  severity  of  the 
infection,  125  to  250  mg.  (200,000 
to  400,000  units)  every  four  to  six 
hours.  For  children,  dosage  is  de- 
termined by  age  and  weight. 

Supplied 

Filmtabs  compocillin-v  (Potas- 
sium Penicillin  V,  Abbott)  come  in 
125  mg.  (200,000  units),  bottles  of 
50;  and  in  250  mg.  (400,000  units), 
bottles  of  25.  Oral  Suspension 
COMPOCiLLiN-v  (Hydrabamine 
Penicillin  V,  Abbott),  contains  180 
mg.  per  5-cc.  teaspoonful,  in  40-cc. 
and  80-cc.  bottles. 


e02071 


THE  HIGHER  BLOOD  LEVELS  OF  COMPOCILLIN-V 

-IN  EASY-TO-SWALLOW  FILMTABS  AND  TASTY,  ORAL  SUSPENSION 


units/cc. 


16 


14 


12 


10 


8 


6 


4 


2 


0 


Filmtab  Compociliin-V 
(Potassium  Penicillin  V,  Abbott) 


Uncoated  Potassium  Penicillin  V 


Buffered  Potassium  Penicillin  G 


Doses  of  400,000  units  were  administered  before 
mealtime  to  40  subjects  involved  in  this  study. 


of  liie  blood  levels  of 


The  chart  repsSiints  a comparison  

FILMTAB  cOMPoaSiLiN-v  (Potassium  Peiaicillin  V,  Abbott) 
with  uncoated  j(^i®ium  penicillin  V,  and  with  buffered 
potassium  penicillin  G.  Bar  heights  sliow  ranges,  while 
crossbars  show  s^edians.  Note  the  higli, ranges  and  aver- 
ages of  FILMTAB  I^MFOCILLIN-V  at  % hbtur,  and  at  1 hour. 


Hours  V2 


1 


2 


4 


Now,  with  Filmtab  compocillin-V,  patients  get  (and  within  minutes)  fast,  high  peni- 
cillin concentrations.  Note  the  blood  level  chart. 

COMPOCILLIN-V  is  indicated  whenever  penicillin  therapy  is  desired.  It  comes  in 
two  highly-acceptable  forms.  Filmtab  compocillin-v  offers  two  therapeutic  dosages 
(125  and  250  mg.).  Patients  find  Filmtabs  tasteless,  odorless  and  easy-to-swallow. 
For  children,  compocillin-v  comes  in  a tasty,  banana-flavored  0 0 ++ 

suspension.  It’s  ready-mixed  — stays  stable  for  at  least  18  months.  vAX)^tjtMX 


Indications 


and  when 
coccal  infections 
hospitalize 
the  patient 


SPONTIN  is  indicated  for  treating  gram- 
positive bacterial  infections.  Clinical 
reports  have  indicated  its  effectiveness 
against  a wide  range  of  staphylococcal, 
streptococcal  and  pneumococcal  infec- 
tions. It  can  be  considered  a drug  of 
choice  for  the  immediate  treatment  of 
serious  infections  caused  by  organisms 
resistant  to  other  antibiotics. 

Dosage 

Recommended  dosage  depends  on  the 
sensitivity  of  the  microorganism  and  on 
the  severity  of  the  disease  under  treat- 
ment. For  pneumococcal  and  streptococ- 
cal infections,  a dosage  of  25  mg./Kg. 
per  day  will  usually  be  adequate.  Major- 
ity of  staphylococcal  infections  will  be 
controlled  by  25  to  50  mg./Kg.  per  day. 
However,  in  endocarditis  due  to  rela- 
tively resistant  strains  or  where  vege- 
tations or  abscesses  occur,  dosages  as 
high  as  75  mg./Kg.  per  day  may  be  used. 
It  is  recommended  that  the  daily  dosages 
be  divided  into  two  or  three  equal  parts 
at  eight-  or  twelve-hour  intervals. 

Supplied 

SPONTIN  is  supplied  as  a sterile,  lyophi- 
lized  powder,  in  vials  representing  500 
mg.  of  ristocetin  activity. 


802070 


W l-t  rltirtfr 


A LIFESAVING  ANTIBIOTIC  AFTER  OTHER  ANTIBIOTICS  HAD  FAILED 


SPONTIN  comes  to  the  medical  profession  with  a clinical  history  of  dramatic  results 
— cases  where  the  patients  were  given  little  chance  of  survival. 

During  these  careful,  clinical  investigations,  lives  were  saved  after  weeks  (and 
sometimes  months)  of  antibiotic  failures.  These  were  the  cases  where  the  infecting 
organisms  had  become  resistant  to  present-day  therapy.  And,  just  as  important, 
were  the  good  results  found  against  a wide  range  of  gram-positive  coccal  infections. 

Essentially,  spontin  is  a drug  for  hospital  use,  for  patients  with  potentially 
dangerous  infections.  In  its  present  form,  spontin  is  administered  intravenously 
using  the  drip  technique.  Dosage  may  be  dissolved  in  5%  dextrose  in  water  or  in 
any  isotonic  or  hypotonic  saline  solution.  Some  of  the  important  therapeutic  points 
of  SPONTIN  include : 

1 successful  short-term  therapy  for  acute  or  subacute  endocarditis 

2 new  antimicrobial  activity  — no  natural  resistance  to  spontin  was  found  in 
tests  involving  hundreds  of  coccal  strains 

3 antimicrobial  action  against  which  resistance  is  rare  — and  extremely  diffi- 
cult to  induce 

4 bactericidal  action  at  effective  therapeutic  dosages. 

SPONTIN  is  truly  a lifesaving  antibiotic.  It  could  save  the  life  0 0 j-i- 

of  one  of  your  patients  — does  your  hospital  have  it  stocked?  VAXXuXMX 


CORRECTS  IRON  DEFICIENCY 
AS  IT  STIMULATES  APPETITE 


FORMULA 

EACH  TEASPOONFUL  (5  cc.)  CONTAINS 

l-Lysine  HCI 

Ferric  Pyrophosphate  (Soluble) 

Iron  (as  Ferric  Pyrophosphate) 

Vitamin  Bja  Crystalline 

Thiamine  Mononitrate  (Bi) 

Pyridoxine  HCI  (Be) 

Alcohol 

Average  dosage  is  one  teaspoonful  daily.  Available  in  bottles  of  4 fl.  oz. 

LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY. 


300  mg. 
250  mg. 
30  mg. 
25  mcgm. 
10  mg. 
5 mg. 
0.75% 


•RE6.  u.  s.  pat.  off. 

PEARL  RIVER.  NEW  YORK 


Provides  the  following  percentages  of  Minimum  Daily  Requirements  per  teaspoonful; 


Child  under  6 

Child  over  6 

Adult 

B, 

2000% 

1333% 

1000% 

Iron 

400% 

300% 

300% 

i 


DIRECTORY 

THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION 
Organized  1882  300  First  Nat’l  Bank  Bldg. 

Sioux  Falls,  South  Dakota 
OFFICERS,  1957-1958 
President 

M.  M.  Morrissey,  M.D Pierre 

President-Elect 

A.  A.  Lampert,  M.D Rapid  City 

Secretary-Treasurer 

A.  P.  Reding,  M.D Marion 

Vice  President 

R.  A.  Buchanan,  M.D — — Huron 

AMA  Delegate 

A.  A.  Lampert,  M.D.  Rapid  City 

Alternate  Delegate  to  AMA 

A.  P.  Reding,  M.D.  Marion 

Chairman  of  the  Council 

Magni  Davidson,  M.D — - - Brookings 

Speaker  of  the  House 

C.  R.  Stoltz,  M.D.  Watertown 

Councilor-at-Large 

A.  P.  Peeke,  M.D.  - Volga 

COUNCILORS 
First  District  (Aberdeen) 

P.  V.  McCarthy,  M.D.  (1959)  - Aberdeen 

Second  District  (Watertown) 

J.  J.  Stransky,  M.D.  (1959)  Watertown 

Third  District  (Brookings-Madison) 

Magni  Davidson,  M.D.  (1960)  Brookings 

Fourth  District  (Pierre) 

L.  C.  Askwig,  M.D.  (1959)  .....Pierre 

Fifth  District  (Huron) 

Paul  Hohm,  M.D.  (1960)  Huron 

Sixth  District  (Mitchell) 

P.  P.  Brogdon,  M.D.  (1960)  _. Mitchell 

Seventh  District  (Sioux  Falls) 

C.  J.  McDonald,  M.D.  (1960)  Sioux  Falls 

Eighth  District  (Yankton) 

T.  H.  Sattler,  M.D.  (1959)  — Yankton 

Ninth  District  (Black  Hills) 

J.  D.  Bailey,  M.D.  (1958)  . Rapid  City 

Tenth  District  (Rosebud) 

R.  H.  Hayes,  M.D.  (1958)  — Winner 

Eleventh  District  (Northwest) 

G.  C.  Torkildson,  M.D.  (1958)  McLaughlin 

Twelfth  District  (Whetstone) 

E.  A.  Johnson,  M.D.  (1958)  Milbank 

STANDING  COMMITTEES  — 1957-1958 
Scientific  Work 

M.  M.  Morrissey,  M.D.,  Chr ...  Pierre 

A.  A.  Lampert,  M.D.  Rapid  City 

R.  A.  Buchanan,  M.D.  Huron 

A.  P.  Reding,  M.D Marion 

Legislation 

H.  Russell  Brown,  M.D.,  Chr Watertown 

R.  E.  Van  Demark,  M.D Sioux  Falls 

E.  T.  Ruud,  M.D.  ...  Rapid  City 

Paul  Bunker,  M.D Aberdeen 

C.  L.  Swanson,  M.D.  Pierre 

H.  R.  Lewis,  M.D.  Mitchell 

Publications 

R.  G.  Mayer,  M.D.,  Chr.  (1960)  ...(Deceased) Aberdeen 

R.  E.  Van  Demark,  M.D.  (1958)  Sioux  Falls 

T.  H.  Sattler,  M.D.  (1959)  ..._ ..Yankton 

Medical  Defense 

A.  P.  Reding,  M.D.,  Chr.  (1958)  Marion 

Russell  Orr,  M.D.  (1959)  Sioux  Falls 

D.  R.  Mabee,  M.D.  (1960)  .Mitchell 

Medical  School  Affairs 
Medical  Education  and  Hospitals 

C.  B.  McVay,  M.D.,  Chr.  (1960)  Yankton 

R.  C.  Jahraus,  M.D.  (1960)  Pierre 

Ronald  Price,  M.D.  (1958)  Armour 

F.  D.  Gillis,  Jr.,  M.D.  (1958)  Mitchell 

W.  H.  Saxton,  M.D.  (1959)  Huron 

F.  R.  Williams,  M.D.  (1959)  Rapid  City 

Medical  Economics 

M.  Davidson,  M.D.,  Chr.  (1958)  Brookings 

Abner  Willen,  M.D.  (1959)  Clark 

R.  H.  Hayes,  M.D.  (1960)  . Winner 

Necrology 

D.  J.  Glood,  M.D.,  Chr.  (1958)  Viborg 

J.  C.  Murphy,  M.D.  (1960)  Murdo 

J.  T.  Cowan,  M.D.  (1959)  Pierre 

Public  Health 

R.  K.  Rank,  M.D.,  Chr.  (1959)  Aberdeen 

F.  C.  Totten,  M.D.  (1958)  Lemmon 

N.  E.  Wessman,  M.D.  (1960)  ....Sioux  Falls 

Cancer 

P.  V.  McCarthy,  M.D.,  Chr.  (1960)  Aberdeen 

W.  A.  Geib,  M.D.  (1958)  Rapid  City 

J.  V.  McGreevy,  M.D.  (1959)  Sioux  Falls 

Tuberculosis 

W.  L.  Meyer,  M.D.,  Chr.  (1960)  Sanator 

R.  G.  Meyer,  M.D.,  Chr.  (1960)  (Deceased) Aberdeen 

Saul  Friefeld,  M.D.  (1959)  Brookings 

Maternal  & Child  Welfare 

Brooks  Ranney,  M.D.,  Chr.  (1959)  Yankton 

L.  W.  Tobin,  M.D.  (1958)  Mitchell 

W.  A.  Anderson,  M.D.  (1960)  Sioux  Falls 

Diabetes 

E.  W.  Sanderson,  M.D.  (1958)  Sioux  Falls 

M.  E.  Sanders,  M.D.  (1959)  Redfield 

Clifford  Gryte,  M.D.  (I960)  Huron 


Executive  Committee 

M.  M.  Morrissey,  M.D.,  Chr.  Pierre 

A.  A.  Lampert,  M.D.  Rapid  City 

R.  A.  Buchanan,  M.D Huron 

C.  R.  Stoltz,  M.I3.  Watertown 

A.  P.  Reding,  M.D Marion 

Magni  Davidson,  M.D.  Brookings 

Grievance  Committee 

L.  J.  Pankow,  M.D.,  Chr.  (1962)  Sioux  Falls 

R.  E.  Jernstrom,  M.D.  (1958)  Rapid  City 

D.  A.  Gregory,  M.D.  (1959)  Milbank 

A.  W.  Spiry,  M.D.  (1960)  Mobridge 

D.  S.  Baughman,  M.D.  (1961)  - Madison 

Mental  Health 

George  Smith,  M.D.,  Chr.  (1960)  Sioux  Falls 

E.  S.  Watson,  M.D.  (1958)  Brookings 

Clark  Johnson,  M.D.  (1958)  Yankton 

R.  C.  Knowles,  M.D.  (1959)  Sioux  Falls 

H.  E.  Davidson,  M.D.  (1959)  Lead 

C.  E.  Baker,  M.D.  (1960)  Yankton 

Benevolent  Fund 

W.  E.  Donahoe,  M.D.,  Chr.  (1960)  _.Sioux  Falls 

J.  C.  Hagin,  M.D.  (1958)  Miller 

F.  C.  Totten,  M.D.  (1959)  Lemmon 

Rheumatic  Fever  and  Heart  Disease 
J.  Argabrlte,  M.D.,  Chr.  (1958)  Watertown 

B.  T.  Lenz,  M.D.  (1959)  Huron 

H.  W.  Farrell,  M.D.  (1960)  Sioux  Falls 

SPECIAL  COMMITTEES 
Radio  Broadcasts  and  Telecasts  Committee 

J.  J.  Stransky,  M.D.,  Chr.  Watertown 

J.  P.  Steele,  M.D Yankton 

J.  C.  Rodine,  M.D Aberdeen 

Robert  Olson,  M.D.  Sioux  Falls 

Wm.  Fritz,  M.D - ^ Mitchell 

F.  D.  Leigh,  M.D.  Huron 

S.  B.  Simon,  M.D - Pierre 

H.  L.  Ahrlin,  M.D Rapid  City 

American  Medical 
Education  Foundation 

A.  P.  Reding,  M.D.,  Chr Marion 

A.  A.  Lampert,  M.D Rapid  City 

O.  J.  Mabee,  M.D Mitchell 

H.  L.  Saylor,  Jr.,  M.D Huron 

S.  F.  Sherrill,  M.D Belle  Fourche 

Editorial 

R.  G.  Mayer,  M.D (Deceased) Aberdeen 

G.  S.  Paulson,  M.D.  Rapid  City 

Harold  Lowe,  M.D Mobridge 

H.  R.  Wold,  M.D Madison 

R.  E.  Van  Demark,  M.D.  Sioux  Falls 

T.  W.  Reul,  M.D.  Watertown 

Mary  Price,  M.D.  ._ Armour 

Amos  Michael,  M.D Vermillion 

M.  L.  Spain,  M.D Rapid  City 

Medical  Licensure 

F.  F.  Pfister,  M.D.  Webster 

Magni  Davidson,  M.D.  Brookings 

C.  E.  Kemper,  M.D Viborg 

Veterans  Administration  and  Military  Affairs 

L.  C.  Askwig,  M.D.,  Chr Pierre 

M.  R.  Gelber,  M.D Aberdeen 

G.  H.  Steele,  M.D.  Aberdeen 

T.  J.  Billion,  M.D.  Sioux  Falls 

Spafford  Memorial  Fund 

T.  E.  Eyres,  M.D.  Vermillion 

Prepayment  and  Insurance  Plans 

C.  J.  McDonald,  M.D.,  Chr.  Sioux  Falls 

D.  H.  Breit,  M.D Sioux  Falls 

Paul  Hohm,  M.D.  Huron 

E.  A.  Johnson,  M.D Milbank 

A.  A.  Lampert,  M.D.  Rapid  City 

Robert  Monk,  M.D.  Yankton 

T.  H.  Sattler,  M.D Yankton 

Rural  Medical  Service 

A.  P.  Peeke,  M.D.,  Chr Volga 

G.  J.  Bloemendaal,  M.D.  Ipswich 

E.  F.  Kalda,  M.D.  _...Platte 

Nursing  Training 

J.  A.  Muggly,  M.D.,  Chr.  Madison 

C.  L.  Vogele,  M.D Aberdeen 

G.  F.  Gryte,  M.D.  Huron 

Workmen’s  Compensation 

J.  N.  Hamm,  M.D.,  Chr.  Sturgis 

H.  R.  Lewis,  M.D Mitchell 

R.  Giebink,  M.D.  _ Sioux  Falls 

Blood  Banks 

W.  A.  Geib,  M.D.,  Chr Rapid  City 

R.  L.  Carefoot,  M.D.  Huron 

A.  K.  Myrabo,  M.D.  Sioux  Falls 

Rehabilitation  Committee 

R.  E.  Van  Demark,  M.D.,  Chr Sioux  Falls 

Paul  Bunker,  M.D Aberdeen 

W.  A.  Dawley,  M.D.  Rapid  City 

H.  L.  Ahrlin,  M.D.  Rapid  City 

Mary  Schmidt,  M.D Watertown 

Press  Radio  Committee 

R.  E.  Jernstrom,  M.D.,  Chr.  Rapid  City 

E.  A.  Rudolph,  M.D.  Aberdeen 

Steve  Brzica,  M.D Sioux  Falls 

Care  of  the  Indigent 

H.  P.  Adams,  M.D.,  Chr.  Huron 

A.  P.  Peeke,  M.D — ; Volga 

H.  Russell  Brown,  M.D Watertown 

F.  F.  Pfister,  M.D.  Webster 

P.  V.  McCarthy,  M.D Aberdeen 

E.  J.  Perry,  M.D Redfield 

R.  F.  Hubner,  M.D Yankton 

C.  A.  Johnson,  M.D.  Lemmon 


S.D.J.O.M.  MARCH  1958  - ADV. 


17 


1.  Recurrent  joint  pain  followed  by 
long  periods  of  complete  remis- 
sion. (Percentages  refer  to  inci- 
dence.) 


3. 


Elevated  serum  uric  acid  levels. 


2 ■ Enlargement  of  bursae  such  as  in 
this  case  involving  the  olecranon 
bursa. 


4i  Colchicine  test:  full  dose  (0.5 
mg. ) every  1 to  2 hours  until  pain 
is  relieved  or  nausea,  vomiting  or 
diarrhea  occur.  The  test  requires 
usually  8 to  16  doses.  Pain  relief 
is  highly  indicative  of  gout. 


FROM  THESE  FINDINGS...SUSPECT  GOUT; 


^BENEMID 

PROBENECID 

A SPECIFIC  FOR  GOUT 


Once  findings  point  to  gout,  long-term  management  can  be  started 
with  Benemid.  This  effective  uricosuric  agent  has  these  unique 
benefits: 


• Urinary  excretion  of  uric  acid  is  approximately  doubled. 

• Serum  uric  acid  levels  are  reduced. 

• Uric  acid  deposits  (tophi)  in  tissues  are  mobilized. 

• Formation  of  new  tophi  can  often  be  prevented. 

• Fewer  attacks  and  severity  is  reduced. 

RECOMMENDED  DOSAGE;  0.25  Gm.  (%  tablet)  twice  daily  for 


one  week  followed  by  1 Gm.  (2  tablets)  daily  in  divided  doses. 
Benemid  is  a trade-mark  of  Merck  & Co.,  Inc. 


MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  & CO.,  Inc.,  PHILADELPHIA  1,  PA. 


18 


S.D.J.O.M.  MARCH  1958  - ADV. 


How  to  provide  unsaturated  fatty  acids 

without  dieting 


With  type  as  well  as  amount  of  fat  in  the  human 
diet  now  assuming  such  importance,  the  new 
role  of  corn  oil  as  a source  of  unsaturated  fatty 
acids  has  prompted  these  questions: 


1  What  is  the  role  of  unsaturated  fats  in 
the  daily  diet? 

answer:  There  is  now  ample  clinical  evidence 
unsaturated  fats  tend  to  lower 
the  serum  cholesterol  level  of  human 
subjects,  whereas  saturated  fats  have 
the  opposite  effect. 

2  How  much  of  the  important  unsaturated 
fatty  acids  does  corn  oil  provide? 

\^nswer:  MAZOLA  Corn  Oil  yields  an  average 
of  85  per  cent  unsaturated  fatty  acids. 
100  grams  of  MAZOLA  will  yield:  53 
grams  of  linoleie  acid  and  28  grams  of 
oleic  acid;  it  also  provides  1.5  grams 
of  sitosterols,  and  only  12  grams  of 
saturated  fatty  acids. 


3  What  is  the  best  way  to  provide  unsatu- 
rated fatty  acids? 

answer:  By  balancing  the  types  of  fat  in  the 
daily  diet.  Many  doctors  now  agree 
that  from  one  third  to  one  half  of  the 
total  fat  intake  should  be  in  the  form 
of  a vegetable  oil  such  as  corn  oil 
(MAZOLA). 


4 


How  is  corn  oil  most  easily  taken  in  the 


usual  daily  diet? 


answer: 


There  is  no  need  to  disturb  the  daily 
routine  of  meals  or  to  have  separate 
diets  for  individual  members  of  the 
family.  MAZOLA  Com  Oil  can  be 
used  instead  of  solid  fats  in  preparing 
and  cooking  foods,  it  is  also  ideal  for. 
salad  dressings. 


O How  can  I obtain  further  information  on  , 
the  value  of  corn  oil  as  a source  of  un-  * 

saturated  fatty  acids?  • 

answer:  The  subject  is  reviewed  in  the  book  * 
‘ “Vegetable  Oils  in  Nutrition.”  Also  • 
available  is  a recipe  book  for  distribu-  I 
tion  to  your  patients.  It  tells  how  to  * 
use  corn  oil  in  everyday  meals.  Both  • 
books  will  be  sent  free  of  charge  to  • 
physicians,  on  request.  5 


F 


S.D.J.O.M.  MARCH  1958  - ADV. 


19 


i 

4 


i 


Monilial  overgrowth 
is  a factor 


Combines  Achromycin  V with  Nystatin 


SUPPUEDc 

CAPSULES  contain  250  mg.  tetracycline  HCl 
equivalent  (phosphate-butfered)  and  250,000 
units  Nystatin.  ORAL  SUSPENSION  (cherry- 
mint  flavored)  Each  5 cc.  teaspoonful  contains 
125  mg.  tetracycline  HCl  equivalent  (phos- 
phate-buffered) and  125,000  units  Nystatin. 


Basic  oral  dosage  (6-7  mg.  per  lb.  body  weight 
per  day)  in  the  average  adult  is  4 capsules  or 
8 tsp.  of  Achrostatin  V per  day,  equivalent 
to  1 Gm.  of  Achromycin  V. 


Achrostatin  V combines  AcHROMYcmt  V 
...  the  new  rapid-acting  oral  form  of  AcHROMYCiNt 
Tetracycline . . . noted  for  its  outstanding 
effectiveness  against  more  than  50  different  infections 
. . . and  Nystatin  . . . the  antifungal  specific. 
Achrostatin  V provides  particularly  effective  j 
therapy  for  those  patients  prone 
to  monilial  overgrowth  during  a protracted  course 
of  antibiotic  treatment. 


LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY.  PEARL  RIVER.  N.  Y. 
^Trademark  tReg.U.  S.  Pat.  Off. 


20 


S.DJ.O.M.  MARCH  1958  - ADV. 


N0W...A  NEW  TREATMENT 


'Cardilate'  tablets  shaped  for  easy  retention 

in  the  buccal  pouch 

**. . . the  degree  of  increase  in  exercise  tolerance  which  sublingual  ery- 
throl  tetranitrate  permits,  approximates  that  of  nitroglycerin,  amyl 
nitrite  and  octyl  nitrite  more  closely  than  does  any  other  of  the  approxi- 
mately 100  preparations  tested  to  date  in  this  laboratory.” 

“Furthermore,  the  duration  of  this  beneficial  action  is  prolonged  suffi- 
ciently to  make  this  method  of  treatment  of  practical  clinical  value.” 

Riseman,  J.  E.  F.,  Altman,  G.  E.,  and  Koretsky,  S.: 
Nitroglycerin  and  Other  Nitrites  in  the  Treatment  of 
Angina  Pectoris,  Circulation  (Jan.)  1958. 


‘Cardllate'  brand  Erythrol  Tetranitrate  SUBLINGUAL  TABLETS,  15  mg.  scored 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  Tuckahoe,  New  York 


The  psychological  needs  of  the  elderly  confront  physicians  with  one  of  their  most 
perplexing  problems.  Perhaps  no  other  patient  group  suffers,  so  much  from  emo- 
tional distress.  Yet,  precisely  because  of  their  age,  geriatric  patients  often  seem 
beyond  the  reach  of  tranquilizing  treatment. 


When  tranquilization  seems  risky  . 


They  are  too  much  beset  by  complicating  chronic  ailments,  too  susceptible  to 
serious  side  effects.  Ataraxia  is  clearly  indicated,  yet  the  doctor  cannot  risk  side 
reactions  on  liver,  blood  or  nervous  system. 


Is  there  an  answer  to  this  dilemma? 


We  feel  there  is.  In  four  recent  papers  investigators  have  reported  good  results  with 
ATARAX  in  patients  up  to  90  years  of  age.*  In  one  study,  improvement  was  “pro- 
nounced” in  76%,  “good”  in  an  additional  18.5%.*  ATARAX  has  been  successfully 
used  in  such  cases  as  senile  anxiety,  agitation,  hyperemotivity  and  persecution 
complex.*  On  atarax,  patients  became  “.  . . quieter  and  more  manageable.  They 
slept  better  and  demonstrated  improved  relations  with  other  patients  and  hospital 
personnel.  Even  their  personal  hygiene  improved,  and  they  required  less  super- 
visory management."* 


ATARAX  is  safe 


Yet  even  in  the  aged,  ATARAX  has  given  "no  evidence  of  toxicity Complete  liver 

function  tests  and  blood  studies  were  made  on  all  patients  after  two  months  of 
therapy.  . . . There  were  no  significant  abnormalities.”*  With  still  other  elderly 
patients  “tolerance  to  the  drug  was  excellent,  even  in  cases  where  the  patients 
were  given  relatively  high  doses.”*  Similarly,  no  parkinsonian  effects  have  been  ob- 
served on  ATARAX  therapy. 


Nor  does  atarax  make  your  patients  want  to  sleep  all  day.  Instead,  they  can  better 
take  care  of  themselves,  because  atarax  leaves  them  both  calm  and  alert.  In  sum, 
ATARAX  “. . . does  not  impair  psychic  function  and  has  a minimum  of  side  effects. 
...  It  appears  that  atarax  is  a safe  drug. . . .”* 


r< . 


;IT>Z|R>!1X 


These,  undoubtedly,  are  the  results  you  want  when  emotional  problems  beset  your 
geriatric  patients.  For  the  next  four  weeks,  won't  you  prescribe  tiny  atarax  tablets 
or  pleasant-tasting  ATARAX  syrup  - both  so  readily  acceptable  to  the  elderly. 


♦Documentation  on  request 


ATARAX 


in  any 

hyperemotive 

state 


(BRAND  OF  HYDROXYZINE) 


for  ehtltfhnod  behavior  disorders 

10  mg.  tablets-  .^-6  years,  one  tab- 
. let  t.i.d.;  over  6 years,  two  tablet'. 
P t.i.cl.  Syrup-3  6 years,  one  tsp. 
Y t.l.il.!  ov»-r  6 years,  two  tr.p.  t.i.ri. 

for  adult  tension  and  anxie^  - 

^^25  mg,  tablets— one  tablet  q.i.d. 

' Syrup“One  tbsp.  q.l.d. 

for  severe  eihotlonat  disturbartces 

100  mg.  tablets-one  tablet  t.i.u. 

for  adult  psychiatric  and  emotional 
emergencies 

Parenteret  Solution— 25-50  mg. 
{1-2  cc.)  intramuscularly,  3-i; 
times  daily,  at  4-hour  inleryals.' 
Dosage  for  children  under  12  not 
established.  ^ 

kSupplied:  Tablets,  bottles  of  100^  Syrup, ; 
{pint  bottles.  Parenteral  Solution,  10  cc. 
iiultipte.(iose  vials. 


ik 


Medical  Birector 


New  York  17,  New  York 

Division,  Chas.  Pfizer  & Co.,  Inc. 


22 


S.DJ.O.M.  MARCH  1958  - ADV. 


• debilitated 

• elderly 

• diabetics 

• infants,  especially  prematures 

• those  on  corticoids 

• those  who  developed  moniliasis  on  previous 
broad-spectrum  therapy 

• those  on  prolonged  and/or 
high  antibiotic  dosage 

• women— especially  if  pregnant  or  diabetic 


the  best  broad-spectrum  antibiotic  to  use  is 

MYSTECLIN-V 

Squibb  Tetracycline  Phosphate  Complex  (Sumycin)  and  Nystatin  (Mycostatin)  Sumycin  plus  Mycostatin 

for  practical  purposes,  Mysteclin-V  is  sodium-free 

for  “built-in”  safety,  Mysteclin-V  combines: 

1.  Tetracycline  phosphate  complex  (Sumycin)  for  superior 
initial  tetracycline  blood  levels,  assuring  fast  transport  of 
adequate  tetracycline  to  the  infection  site. 

2.  Mycostatin—the  first  safe  antifungal  antibiotic— for  its 
specific  antimonilial  activity.  Mycostatin  protects 

many  patients  (see  above)  who  are  particularly  prone  to  monilial 
complications  when  on  broad-spectrum  therapy. 


MYSTECLIN-V  PREVENTS  MONILIAL  OVERGROWTH 

Capaules  (250  mg./250,000  u.).  bottles 
of  16  and  100.  Half-Strength  Capsules 
(125  mg./125,000  u.),  bottles  of  16 
and  100.  Suspension  (125  m8r./125,000 
u.),  2 oz.  bottles.  Pediatric  Drops  (100 
mg./100,000  u.),  10  cc.  dropper  bottles. 


Squibb 

Squibb  Quality— 
the  Priceless  Ingredient 


‘HYSTECLIN,-*  •MYCOSTATIN'.®  ANO  ‘SVMVCIN-  ARE  SOVlBO  TRADEMARKS 


25  PATIENTS  ON 

TETRACYCLINE  ALONE 

25  PATIENTS  ON 

TETRACYCLINE  PLUS  MYCOSTATIN 

Before  therapy 

After  seven  days 
of  therapy 

Before  therapy 

After  seven  days 
of  therapy 

® # 

0 # ® # # 

m m m 

m mm  m m 

m mm  m m 

# ® ® # # 

m mm  m m 

m mm  m ® 

# • • • • 

® # # « • 

m mm  m m 

• • • e • 

m mm  m m 

m m m 

Monilial  overgrowth  (rectal  swab)  ^ None  ^ Scanty  ^ Heavy 

Childs,  A.  J.:  British  M.  J.  1:660  1956. 


S.D.J.O.M.  MARCH  1958  - ADV. 


23 


How 


I 


The  Best  Tasting  Aspirin  you  can  prescribe. 

The  Flavor  Remains  Stable  down  to  the  last  tablet. 

2bi  Bottle  of  48  tablets  (IM  grs.  each). 

We  will  be  pleased  to  send  samples  on  request. 

THE  BAYER  COMPANY  DIVISION  of  sterling  Drug  Inc.  1450  Broadway.  New  York  18,  N.  Y. 


24 


S.D.J.O.M.  MARCH  1958  - ADV. 


respiratory  congestion 


reiiet  in  minutes . . iasts  tor 


oraLiy 

hours 


In  the  common  cold,  nasal  allergies,  sinus- 
itis, and  postnasal  drip,  one  timed-release 
Triaminic  tablet  brings  welcome  relief  of 
symptoms  in  minutes.  Running  noses  stop, 
clogged  noses  open- — and  stay  open  for  6 to 
8 hours.  The  patient  can  breathe  again. 

With  topical  decongestants,  “unfortu- 
nately, the  period  of  decongestion  is  often 
followed  by  a phase  of  secondary  reaction 
during  which  the  congestion  may  be  equal 
to,  if  not  greater  than,  the  original  condi- 
tion. . . The  patient  then  must  reapply 
the  medication  and  the  vicious  cycle  is 
repeated,  resulting  in  local  overtreatment, 
pathological  changes  in  nasal  mucosa,  and 
frequently  “nose  drop  addiction.” 

Triaminic  does  not  cause  secondary  con- 
gestion, eliminates  local  overtreatment  and 
consequent  nasal  pathology. 

•Morrison,  L.  F.:  Arch.  Otolaryng.  59:48-63  (Jan.)  1954. 

Each  double-dose  “timed-release"  triaminic 

Tablet  contains: 

Phenylpropanolamine  hydrochloride  50  mg. 


Pyrilamine  maleate 25  mg. 

Pheniramine  maleate 25  mg. 


Dosage:  1 tablet  in  the  morning,  afternoon,  and 
in  the  evening  if  needed. 


Each  double-dose  ^‘timed-release** 
tablet  keeps  nasal  passages 
clear  for  6 to  8 hours — 
provides  “around-the-clock** 
freedom  from  congestion  on 
just  three  tablets  a day 


disintegrates  to  give  3 to  4 
more  hours  of  relief 


Also  available:  Triaminic  Syrup,  for  children  and 
those  adults  who  prefer  a liquid  medication. 


Triaminic 


^‘timed-release’* 

tablets 


running  noses . . 


and  open  stuffed  noses  orally 


SMITH-DORSEY  • a division  of  The  Wander  Company  . Lincoln,  Nebraska  • Peterborough,  Canada 


Three  advantages  of 

glucosamine-potentiated 

tetracycline: 


in  new 

well-tolerated 

COSA-TETRACYN 


(CHLOROTHIAZIDE) 


in 


EDEMA 

Start  therapy  with  one  or  two  500  mg, 
tablets  of  'diurw  once  or  twice  a day, 

BENEFITS: 

• The  only  orally  effective  nonmercurial  agent 
with  diuretic  activity  equivalent  to  that  of  the 
parenteral  mercurials. 

• Excellent  for  initiating  diuresis  and  maintaining 
the  edema-free  state  for  prolonged  periods. 

• Promotes  balanced  excretion  of  sodium  and 
chloride— without  acidosis. 

Any  indication  for  diuresis  is  an  in- 
dication for  'DIURIU: 

Congestive  heart  failure  of  all  degrees  of  severity; 
premenstrual  ssmdrome  (edema) ; edema  and  toxe- 
mia of  pregnancy;  renal  edema — nephrosis;  ne- 
phritis; cirrhosis  with  ascites;  drug-induced  edema. 
May  be  of  value  to  relieve  fluid  retention  compli- 
cating obesity. 

SUPPLIED:  250  mg.  and  500  mg.  scored  tablets  'DIURIL' 
(chlorothiazide);  bottles  of  100  and  1,000. 

'diuril'  and  'inversinb'  are  trade-marks  of  Merck  & Co.,  Inc. 

MERCK  SHARP  & DOHME 

Division  of  MERCK  & CO.,  Inc.,  Philadelphia  1.  Pa. 


as  simple 
as  1~ 
in 


HYPEimNSION 


1 

z 


INITIATE  'DIURIL'  THERAPY 

'DIURIL'  is  given  in  a dosage  range  of  from  250 
mg.  twice  a day  to  500  mg.  three  times  a day. 

ADJUST  DOSAGE  OF  OTHER  AGENTS 

The  dosage  of  other  antihypertensive  medication 
(reserpine,  hydralazine,  etc.)  is  adjusted  as  indi- 
cated by  patient  response.  If  the  patient  is  estab- 
lished on  a ganglionic  blocking  agent  (e.g.,  'IN- 
VERSINE')  this  should  be  continued,  but  the  total 
daily  dose  should  be  immediately  reduced  by  25 
to  50  per  cent.  This  will  reduce  the  serious  side 
effects  often  observed  with  ganglionic  blockade. 


ADJUST  DOSAGE  OF  ALL  MEDICATION 

The  patient  must  be  frequently  observed  and  care- 
ful adjustment  of  all  agents  should  be  made  to 
determine  optimal  maintenance  dosage. 


BENEFITS: 

• improves  and  simplifies  the  management  of  hypertension 

• markedly  enhances  the  effects  of  antihypertensive  agents 

• reduces  dosage  requirements  for  other  antihypertensive 
agents— often  below  the  level  of  distressing  side  effects 

• smooths  out  blood  pressure  fluctuations 

INDICATIONS:  management  of  hypertension 


Smooth,  more  trouble-free  manage- 
ment of  hypertension  with  'DIURIU 


Symptomatic  refief  of  aches,  pains,  fever,  coryza,  and  rhinorrhea  associated 
with  upper  respiratory  tract  infections. 

Prevention  of  secondary  pyogenic  infections  due  to  tetracycline-sensitive  or^ 
ganisms  — which  often  follow  viral  Infections  of  the  upper  respiratory  tract, 


JBFiStol  laboratories  INC.  SYRACUSE,  NEW  YORK 


VI 


MEDICATION 


“flu,”  “grippe,”  “virus”  and  the  common  cold 


TetrexrMk-'h 

SSBMKlk  ssm  atapa  iasgga  0 


with 


BRISTAMIN 

TETRACYCLINE  PHOSPHATE  COMPLEX  WITH  PHENYLTOLOXAMINE  AND  APC 


Each  TETREX-APC  WITH  BRISTAMIN  Capsule  contains: 

'#•  ■ 

A broad-spectrum  ontibiotic  ,3^;,  " 

TETREX  (fetracycUne  phosphate  complex) .i.-'K...... 125  mg. 

jgs  (tetracycline  HCI  activity) 

f ^ 

An  established  analgesic-antipyretic  combinotion 

Aspirin  150  mg. 

Phenocetin  120  mg. 

Caffeine  «k««e«4e«e«4«*ae*«»e«>*fr***k«*»««*#*****>>*«»***««>«*>«r»*d****#*»e«*4*<«k*'k*4*t «*■«,«,»»««•******«*  30  mg.^  • 

.0*  /f'  . ■ ■•  ^;’sv  ■ 

■w 

4 ^ A dependable  antihistamine 


BRISTAMIN  (phenyltoloxamine,  Bristol) 


25  mg. 


Dosage;  Aduitu  2 capsules  at  onset  of  symptoms,  followed  by  2 capsules  3 or  4 
times  a day  for  3 to  ^days.  Children,  6 to  12  yrs.;  One-half  adult  dose. 

4if.  -M  j' 

Supplied:  Bottles  of  24  and  100  capsules.  <,  >—  r rv, 

% 'C  - ^ 


30 


S.D.J.O.M.  MARCH  1958  - ADV. 


A versatile,  well-balanced  formula  offering  in  one  tablet  the 
drugs  often  prescribed  separately  for  treating  upper  respira- 
tory infections. 

Traditional  and  nonspecific  nasopharyngeal  symptoms 
of  malaise  and  chilly  sensations  are  rapidly  relieved,  and 
headache,  muscular  pain,  and  pharyngeal  and  nasal  dis- 
charges are  reduced  or  eliminated. 

Early  effective  therapy  is  provided  against  such  bacterial 
complications  as  sinusitis,  otitis,  bronchitis  and  pneumonitis 
to  which  the  patient  may  be  highly  vulnerable  at  this  time. 

Adult  dosage  for  Achrocidin  Tablets  and  new,  caffeine- 
free  Achrocidin  Syrup  is  two  tablets  or  teaspoonfuls  of 
syrup  three  or  four  times  daily.  Dosage  for  children  reduced 
according  to  weight  and  age. 

Available  on  prescription  only. 


TABLETS  (Sugar-coated) 

Each  tablet  contains: 

Achromycin®  Tetracycline  125  mg. 

Phenacetin 120  mg. 

Caffeine  30  mg. 

Salicylamide  150  mg. 

Chlorothen  Citrate  25  mg. 

Bottles  of  24  and  100 


SYRUP  (Lemon  -lime  flavored) 

Each  teaspoonful  (3  cc.)  contains: 
Achromycin®  Tetracycline 

equivalent  to  tetracycline  HCl  ..  125  mg. 


Phenacetin  120  mg. 

Salicylamide  150  mg. 

Ascorbic  Acid  (C)  25  mg. 

Pyrilamine  Maleate  15  mg. 

Methylparaben  4 mg. 

Propylparaben  1 mg. 

Bottle  of  4 oz. 


checks 

symptoms 


LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER.  NEW  YORK 

♦Trademark 


I 


for  simultaneously  combating 
inflammation,  allergy,  infection 


(0.5%  prednisolone  acetate  and  10%  sulfacetamide  sodium - 
5 cc.  dropper  bottle) 


(0.5%  prednisolone  acetate,  10%  sulfacetamide  sodium  and 
0.25%  neomycin  sulfate— % oz.  tube) 


for  ocular 
allergies 


eye 
disorders 
look  to  these 


®i^iir(0.2%  prednisolone 


acetate  and 
0.3%  Chlor-Trimeton®— 
5 cc.  dropper 
bottle) 


Standard  for  ocular  infections 


(Sulfacetamide  Sodium  U.S.E— 5 and  IS  cc.  dropper  bottles) 


(15  cc.  dropper  bottle) 


aV;  © 


(vs  oz.  tube) 


SCHERING  CORPORATION  ♦ BLOOMFIELD,  NEW  JERSEY 


32 


S.DJ.O.M.  MARCH  1958  - ADV. 


The  non-narcotic  analgesic  with  the  potency  of  codeine 


DARVON  (Dextro  Propoxyphene 
Hydrochloride,  LUly)  is  equally  as  po- 
tent as  codeine  yet  is  much  better 
tolerated.  Side-effects,  such  as  nausea 
or  constipation,  are  minimal.  You  will 
find  ‘Darvon’  helpful  in  any  condition 
associated  with  pain.  The  usual  adult 
dose  is  32  mg.  every  four  hours  or  65 
mg.  every  six  horns  as  needed.  Avail- 
able in  32  and  65-mg.  pulvules. 


DARVON  COMPOUND  (Dextro  Pro- 
poxyphene and  Acetylsalicylic  Acid 
Compound,  Lilly)  combines  the  antipy- 
retic and  anti-inflammatory  benefits  of 
‘A.S.A.  Compoimd’*  with  the  analgesic 
properties  of  ‘Darvon.’  Thus,  it  is  useful 
in  relieving  pain  associated  with  recur- 
rent or  chronic  disease,  such  as  neural- 
gia, neuritis,  or  arthritis,  as  well  as  acute 
pain  of  traumatic  origin.  The  usual  adult 
dose  is  1 or  2 pulvules  every  six  hours 
as  needed. 


Each  Pulvule  'Darvon  Compound’  provides; 


‘Darvon’  32  mg. 

Acetophenetidin 162  mg. 

‘A.S.A.’  {Acetylsalicylic  Acid,  Lilly) 227  mg. 

Caffeine 32.4  mg. 


*‘A.S.A.  Compound’  (Acetylsalicylic  Acid  and  Acetophenetidin  Compound,  Lilly) 


ELI  LILLY  AND  COMPANY  • INDIANAPOLIS  6.  INDIANA,  U.  S,  A. 


820260 


S.D.J.O.M.  MARCH  1958  - ADV. 


33 


EFFECTIVE,  DEPENDABLE  THERAPY  FOR  VAGINITIS 


Floraquin®  eliminates 
trichomonal  and  mycotic  infection; 
restores  normal  vaginal  acidity 


Leukorrhea  is  by  far  the  most  frequent  symp- 
tom of  vaginitis;  trichomonads  and  monilia  are 
the  most  common  causes.  Many  authors  have 
reported^  trichomonal  protozoa  in  the  vagina 
of  25  per  cent  of  obstetric  and  gynecologic 
patients.  Increased  use  of  broad  spectrum 
antibiotics  has  resulted  in  a sharp  rise  in  the 
incidence  of  monilial  infections. 

Floraquin  effectively  eradicates  both  tricho- 
monal and  monilial  vaginal  infections  through 
the  action  of  its  Diodoquin®  content.  Floraquin 
also  furnishes  boric  acid  and  sugar  to  restore 
the  normal  vaginal  acidity  which  inhibits  patho- 


gens and  favors  the  growth  of  protective  Doder- 
lein  bacilli. 

Pitt^  recommends  vaginal  insufflation  of 
Floraquin  powder  daily  for  three  to  five  days, 
followed  by  acid  douches  and  the  daily  inser- 
tion of  Floraquin  vaginal  tablets  throughout  one 
or  two  menstrual  cycles.  G.  D.  Searle  & Co., 
Chicago  80,  Illinois.  Research  in  the  Service  of 
Medicine. 


1.  Pitt,  M.  B.;  Leukorrhea.  Causes  and  Management,  J.  M. 
A.  Alabama  25:182  (Feb.)  1956. 

2.  Parker,  R.  T.;  Jones,  C.  P.,  and  Thomas,  W.  L.:  Pruritus 
Vulvae,  North  Carolina  M.  J.  26:570  (Dec.)  1955. 


s 


34 


S.D.J.O.M.  MARCH  1958  - ADV. 


when  you  encounter 

• respiratory  infections 

• gastrointestinal 
infections 

• genitourinary 
infections 

• miscellaneous 
infections 


for  all 

tetracycline-amenable 
infections, 
prescribe  superior 


SUIMYCIN 

Squibb  Tetracycline  Phosphate  Complex 


Squibb 


Squibb  Quality— 
the  Priceless  Ingredient 


In  your  patients,  sumycin  produces: 

1.  Superior  initial  tetracycline  blood  levels— faster  and  higher 
than  ever  before— assuring  fast  transport  of  adequate  tetra- 
cycline to  the  site  of  the  infection. 

2.  High  degree  of  freedom  from  annoying  or  therapy-inter- 
rupting side  effects. 


Tetracycline  phosphate 
complex  equiv,  to 

Supply:  tetracycline  HCl  (mg,)  Packaging: 


Sumycin  Capsules  (per  Capsule)  250  Bottles  of  16  and  100 

Sumycin  Suspension  (per  5 cc.)  125  2 oz.  bottles 


Sumycin  Pediatric  Drops  100  10  cc.  dropper  bottles 

(per  cc.— 20  drops) 


*SUMrCIN‘  IS 


IBB  TRAOCMABK 


MY  PAP 


”It  happened  I m 
at  work  \ f 

while  he 
was  putting 
oil  in 
something” 


"He  told 
Mom  his 
shoulder 
felt  like 
it  was  on 
fire" 


"He  couldn’t 
swing  a hat 
without 
hurting" 


"But  Doctor 
gave  him 
some  nice 
pills  — and 
the  pain 
went  away 


fast' 


"Dad  said 
we’d  play 
hall  again 
tomorrow 
when  he 
comes  home" 


New  "demi"  strength  permits  dosage  flexibility  to  meet 
each  patient’s  specific  needs.  Percodan-Demi  provides 
the  Percodan  formula  with  one-half  the  amount  of  salts 
of  dihydrohydroxycodeinone  and  homattopine. 

AVERAGE  ADULT  DOSE:  1 tablet  every  6 hours.  May 
be  habit-forming.  Available  through  all  pharmacies. 

Each  Percodan*  Tablet  contains  4.50  mg.  dihydrohydroxyco- 
deinone hydrochloride,  0.38  mg.  dihydrohydroxycodeinone 
terephthalate,  0.38  mg.  homatropine  terephthalate,  224  mg. 
acetylsalicylic  acid,  160  mg.  phenacetin,  and  32  mg.  caffeine. 


ENDO  LABORATORIES 

Richmond  Hill  18,  NewYork 


AND  THE  PAIN 
WENT  AWAY  FAST 


U.S.  Pat.  2.628,185 


36 


S.DJ.O.M.  MARCH  1958  - ADV. 


THE  SOUTH  DAKOTA  JOURNAL 
OF  MEDICINE 

300  First  National  Bank  Sioux  Falls,  S.  D. 

Subscription  $2.00  per  year  20c  per  copy 

CONTRIBUTORS 

MANUSCRIPTS:  Material  appearing  in  all  publi- 
cations of  the  Journal  of  Medicine  should  be  type- 
written, double-spaced  and  the  original  copy,  not 
the  carbon  should  be  submitted.  Footnotes  should 
conform  with  this  request  as  well  as  the  name  of 
author,  title  of  article  and  the  location  of  the  author 
when  manuscript  was  submitted.  The  used  manu- 
script is  not  returned  but  every  effort  will  be  used 


to  return  manuscripts  not  accepted  or  published 
by  the  Journal  of  Medicine. 

ILLUSTRATIONS:  Half-tones  and  zinc  etchings 
will  be  furnished  by  The  South  Dakota  Journal  of 
Medicine  when  satisfactory  photographs  or  draw- 
ings are  supplied  by  the  author.  Each  illustration, 
table,  etc.,  should  bear  the  author’s  name  on  the 
back.  Photographs  should  be  clear  and  distinct. 
Drawings  should  be  made  in  black  India  ink  on 
white  paper.  Used  illustrations  are  returned  after 
publication,  if  requested. 

REPRINTS:  Reprints  should  be  ordered  when 
galley  proofs  are  submitted  to  the  authors.  Type 
left  standing  over  30  days  will  be  destroyed  and 
no  reprint  orders  will  be  taken.  All  reprint  orders 
should  be  made  directly  to  the  South  Dakota 
Journal  of  Medicine,  300  First  Nat’l  Bank,  Sioux 
Falls,  South  Dakota. 


(Continued  from  Page  12) 

Committee  on  Civil  Defense 

L.  C.  Askwig,  M.D.,  Chr.  Pierre 

G.  J.  Bloemendaal,  M.D.  ^ Ipswich 

P.  V.  McCarthy,  M.D.  — ...  Aberdeen 

Commission  for  Improvement  of  Patient  Care 
R.  Delaney,  M.D.,  Chr.  (1960)  Mitchell 

M.  Sanders,  M.D.  (1960)  Redfield 

C.  L.  Vogele,  M.D.  (1958)  Aberdeen 

C.  F.  Gryte,  M.D.  (1958)  Huron 

J.  A.  Muggly,  M.D.  (1959)  Madison 

R.  A.  Buchanan,  M.D.  (1959)  Huron 

Committee  on  School  Health 

R.  G.  Mayer,  M.D.,  Chr Aberdeen 

W.  A.  Anderson,  M.D.  Sioux  Falls 

N.  R.  Whitney,  M.D Rapid  City 

Committee  on  Budget  and  Audit 

A.  P.  Reding,  M.D.,  Chr Marion 

A.  A.  Lamport,  M.D.  Rapid  City 

C.  R.  Stoltz,  M.D Watertown 

Hunters  Fall  Medical  Meeting 

W.  A.  Delaney,  M.D.,  Chr.  Mitchell 

H.  R.  Lewis,  M.D Mitchell 

L.  W.  Tobin,  M.D Mitchell 

Committee  on  Aging 

Warren  Jones,  M.D.,  Chr.  Sioux  Falls 

J.  W.  Argabrite,  M.D Watertown 

M.  P.  Merryman,  M.D Rapid  City 

DISTRICT  OFFICERS 
DISTRICT  1 

President  A.  Keegan,  M.D.,  Aberdeen,  S.  D. 

Vice-President  ... G.  H.  Steele,  M.D.,  Aberdeen,  S.  D. 

Secretary-Treasurer W.  E.  Gorder,  M.D.,  Aberdeen,  S.  D. 

DISTRICT  2 

President  S.  W.  Allen,  Jr.,  M.D.,  Watertown,  S.  D. 

Vice-President  B.  Brewster,  M.D.,  Watertown,  S.  D. 

Secretary-Treasurer T.  J.  Wrage,  Jr.,  M.D.  Watertown,  S.  D. 

DISTRICT  3 

President . — — S.  E.  Friefeld,  M.D.,  Brookings,  S.  D. 

Vice-President C.  S.  Roberts,  Jr.,  M.D.,  Brookings,  S.  D. 

Secretary-Treasurer C.  M.  Kershner,  M.D.,  Brookings,  S.  D. 


DISTRICT  4 

President R.  C.  Jahraus,  M.D.,  Pierre,  S.  D. 

Vice-President  J.  C.  Murphy,  M.D.,  Murdo,  S.  D. 

Secretary-Treasurer... J.  T.  Cowan,  M.D.,  Pierre,  S.  D. 


DISTRICT  5 

President Ted  Hohm,  M.D.,  Huron,  S.  D. 

Vice-President Roscoe  Dean,  M.D.,  Wess.  Springs,  S.  D. 

Secretary-Treasurer Fred  Leigh,  M.D.,  Huron,  S.  D. 

DISTRICT  6 

President  .. F.  D.  Gillis,  Jr.,  M.D.,  Mitchell,  S.  D. 

Vice-President D.  R.  Nelimark,  M.D.,  Mitchell,  S.  D. 

Secretary-Treasurer... R.  J.  Delaney,  M.D.,  Mitchell,  S.  D. 


DISTRICT  7 

President  ...F.  C.  Kohlmeyer,  M.D.,  Sioux  Falls,  S.  D. 

Vice-President C.  S.  Larson,  M.D.,  Sioux  Falls,  S.  D. 

Secretary  ...A.  K.  Myrabo,  M.D.,  Sioux  Falls,  S.  D. 

Treasurer D.  L.  Ensberg,  M.D.,  Sioux  Falls,  S.  D. 


DISTRICT  8 

President  ...  ..  R.  Monk,  M.D.,  Yankton,  S.  D. 

Vice-President ..  A.  C.  Michael,  M.D.,  Vermillion,  S.  D. 

Secretary W.  F.  Strange,  M.D.,  Yankton,  S.  D. 

Treasurer A.  Andre,  M.D.,  Vermillion,  S.  D. 


DISTRICT  9 

President  S.  F.  Sherrill,  M.D.,  Belle  Fourche,  S.  D. 

Vice-President  R.  Boyce,  M.D.,  Rapid  City,  S.  D. 

Secretary-Treasurer Wayne  Geib,  M.D.,  Rapid  City,  S.  D. 


DISTRICT  10 

President  F.  J.  Clark,  M.D.,  Gregory,  S.  D. 

Secretary-Treasurer  Peter  Lakstigala,  M.D.,  White  River,  S.  D. 


DISTRICT  11 


Secretary-Treasurer B.  P.  Nolan,  M.D.,  Mobridge,  S.  D. 

DISTRICT  12 

President  E.  A.  Johnson,  M.D.,  Milbank,  S.  D. 

Vice-President W.  H.  Karlins,  M.D.,  Webster,  S.  D. 

Secretary-Treasurer Dagfin  Lie,  M.D.,  Webster,  S.  D. 


1 


CESAREAN  SECTION  IN  THE  COUNTRY 
A PRELIMINARY  REPORT 
Robert  H.  Hayes.  M.D.  and  H.  D.  Phelps,  M.D. 
Winner.  South  Dakota 


The  purpose  of  this  preliminary  report  is  to 
compare  the  results  of  Cesarean  Section  in 
small  country  hospitals  with  those  of  the 
larger  hospitals  to  see  if  Cesarean  Section  in 
one  of  these  small  hospitals  is  obstetrically 
i feasible.  Obviously,  this  report  is  preliminary 
■ because  the  very  few  sections  that  are  done 
( place  a demand  of  a good  many  years  to  col- 
lect a few  hundred  cases.  The  period  of  1950- 
1956  was  chosen  because  in  our  rural  South 
Dakota  area,  under  the  impetus  of  the  Hill- 
Burton  Act,  three  new  modern  community 
hospitals  were  built.  Each  of  these  is  less 
than  thirty  beds.  Doctors  in  this  vast  rural 
territory  had  always  been  doing  their  own 
emergency  sections  but  with  new  hospitals 
came  new  doctors  and  the  desire  to  do  the 
elective  sections  and  repeat  sections.  We  are 
' trying  to  evaluate  whether  our  results  war- 
! rant  doing  other  than  emergency  Cesarean 
! Sections  in  such  hospitals. 

The  facilities  are  standard.  No  recovery 
i rooms  are  available  but  usually  only  one 
I operation  is  done  in  one  day  in  such  hospitals 
which  means  that  the  entire  hospital  is  a re- 
covery room  and  the  whole  hospital  staff  is 
the  recovery  room  staff.  Blood  is  available 
from  a walking  blood  bank  system.  Anes- 
thesia was  the  point  of  trouble  but  is  now 
becoming  less  of  a problem  with  more  trained 
personnel  becoming  available.  Here  the  word 
‘trained’  personnel  means  individuals  who 
may  not  be  Board  Certified  Anesthesiologists, 
Registered  Nurse  Anesthetists,  but  personnel 
who  have  had  some  formal  anesthesia  train- 
ing and  who  do  give  anesthesia. 


The  sections  represent  those  done  by 
twelve  different  Medical  Doctors  in  three 
different  hospitals.  They  cover  a period  of 
1950-1956.  Some  are  elective  or  repeat  sec- 
tions and  others  are  done  for  the  various 
reasons  indicated.  Dr.  Greenhill  states  that 
each  year  the  number  of  sections  performed 
in  the  United  States  increases  at  a higher  and 
higher  ratio  to  the  total  number  of  births  and 
that  only  part  of  this  is  due  to  repeat  Ce- 
sarean Section.^  This  group  of  cases  also  rep- 
resents this  trend. 

From  a series  of  3,511  deliveries  our  num- 
ber of  Cesarean  Sections  was  seventy  (70),  to 
give  a Cesarean  Section  rate  of  one  and  nine 
tenths  percent  (1.9%).  This  compares  favor- 
ably with  the  national  average  which  as  can 
be  seen  from  table  number  one  (#1),  varies 
between  seven  tenths  percent  (0.7%),  and  four 
and  nine  tenths  percent  (4.9%).  Our  number 
of  cases  compared  with  the  above  average  is 
not  a great  deal  different.  As  the  reader  will 
observe  in  the  series  we  report  our  cases  of 
repeat  sections  will  indicate  a trend  to  do 
elective  ‘repeat  Cesarean  Section’  in  the  small 
country  hospitals.  Previously,  anesthesia  has 
provided  the  biggest  drawback  in  our  plan- 
ning to  do  elective  Cesarean  Sections.  When 
we  were  limited  to  spinal  anesthesia  we  noted 
that  our  patients  were  going  to  medical  cen- 
ters for  elective  sections  so  that  they  could 
take  advantage  of  the  general  anesthesia 
which  was  offered.  More  recently  we  have 
observed  that  more  and  more  of  our  patients 
are  asking,  “may  we  be  asleep”?  We  are  also 


\k 


— 77 


SOUTH  DAKOTA 


TABLE  fil 


INCIDENCE  OF  CESAREAN  SECTION 


CESAREAN 

PERIOD  OF 

REF. 

INSTITUTION 

DELIVERIES 

SECTIONS 

TIME  COVERED 

% 

1. 

North  Side  Unit, 
Youngstown  Hospital 

32,238 

1,011 

1948-April  30,  1956 

3 

Youngstown,  Ohio 

2. 

Grady  Memorial  Hospital 

Atlanta,  Georgia 

27,972 

197 

1948-June  1953 

0.7 

3. 

George  Washington 
University  Hospital 

Garfield  Memorial  Hospital 

27,590 

1,177 

April  1948-December  1952 

4.3 

Washington,  D.  C. 

4. 

Tulane  Service 

New  Orleans,  Louisiana 

43,007 

1,105 

1949-1952 

2.56 

Charity  Hospital 

New  Orleans,  Louisiana 

12,095 

450 

1949-1952 

3.72 

6. 

St.  Joseph  Hospital 
Lexington,  Kentucky 

5,872 

110 

1949-1953 

Good  Samaritan  Hospital 

2.6 

Lexington,  Kentucky 

7,642 

237 

1949-1953 

8. 

St.  Vincent’s  Hospital 

New  York,  New  York 

15,429 

536 

1932-1946 

3.5 

9. 

Charlotte  Memorial  Hospital 

Charlotte,  North  Carolina 

10,093 

904 

1940-1952 

4.5 

10. 

Grace  Hospital 

Detroit,  Michigan 

34,598 

1,707 

1950-1955 

4.93 

13. 

Evanston,  Hospital 
Evanston,  Illinois 

21,612 

896 

1930-1950 

4.14 

14. 

Rosebud  Community  Hospital 

Winner,  South  Dakota 
Burke  Memorial  Hospital 
Burke,  South  Dakota 
Mother  of  Grace  Hospital 

3,511 

70 

1950-1956 

1.9 

Gregory,  South  Dakota 

— 78  — 


MARCH  1958 

finding  it  more  difficult  to  say,  as  we  once 
did,  “you  must  be  awake,  that  is  the  best 
way.”  Now  that  we  have  a choice  of  anes- 
thesia we  find  that  we  are  doing  more  of  our 
repeat  Cesarean  Sections.  The  question  is 
should  we  be  doing  them? 

Reasons  For  Sections 

Since  a great  deal  of  obstetric  judgment 
and  thinking  must  lie  behind  the  decision  to 
do  a Cesarean  Section  on  a patient  for  the 
first  time  it  is  of  some  interest  to  note  the 
reasons  given  in  this  series  of  cases.  One  must 
bear  in  mind  that  in  such  hospitals  as  these 
the  doctor  makes  his  own  decision.  Obstetric 
consultation  is  not  available  as  such.  More- 
over, no  consultation  is  required  in  two  of 
these  three  hospitals.  Of  greater  import,  the 
records  kept  are  not  complete  enough  to 
ascertain  the  reason  for  Cesarean  Section  in 
all  of  the  cases.  Of  the  twenty  eight  (28)  sec- 
tions done  on  a patient  for  a first  baby,  thir- 
teen (13)  were  done  for  cephalopelvic  dis- 
proportion. All  of  these  patients  had  a trial 
labor,  of  at  least  eight  (8)  hours.  There  is  in- 
cluded a case  of  cervical  stenosis.  It  is  felt 
that  here  obstetric  consultation  might  have 
helped.  From  our  brief  survey  of  the  litera- 
ture, we  could  find  no  cases  of  Cesarean  Sec- 
tion done  for  cervical  stenosis.  Perhaps 
obstetric  consultation  would  have  helped 
make  a decision  to  deliver  this  patient  from 
below.  There  is  one  case  of  uterine  inertia. 
This,  from  the  records,  appears  to  be  a matter 
of  debate  as  to  whether  the  patient  was  in 
labor,  but  the  patient  was  sectioned  for  this 
reason.  One  listed  indication  of  ‘elective 
premium  baby’  actually  seems  clear  enough 
from  the  standpoint  of  the  attending  doctor, 
but  again  consultation  might  have  helped. 
The  one  breech  presentation  was  in  an  older 
thirty  eight  (38)  year  primipara.  This  seemed 
to  be  a reasonable  way  to  solve  this  problem 
in  the  country  and  we  do  not  feel  that  many 
of  our  colleagues  would  disagree  with  this  be- 
cause of  the  patient’s  age. 

The  type  of  Cesarean  Section  done  in  this 
series  is  with  no  exception  the  classic  section. 
To  discuss  a point  more  than  adequately  cov- 
ered by  Falls,  is  not  our  intent. ^ We  have 
done  classic  sections  because  they  by  far  and 
large  were  what  the  older  men  who  have  pre- 
ceeded  us  were  taught  to  do.  They  found  this 
fast  and  adequate  to  gain  the  result  of  a live 
baby.  Now  that  the  concept  of  doing  repeat 


Cesarean  Sections  has  entered  into  the  think- 
ing of  country  doctors,  we  feel  that  all  of  our 
colleagues  will  begin  to  think  of  doing  a low 
cervical  Cesarean  Section.  We  predict,  how- 
ever, that  the  classic  type  section  will  remain 
the  one  of  choice  even  though  the  low  cer- 
vical will  be  used  at  times.  This  probably 
can  be  explained  on  the  basis  that  the  men 
who  have  been  using  classic  section  method 
will  continue  to  do  so  because  the  results 
they  have  gained  are  satisfactory. 

From  table  number  two  (#2)  which  attempts 
to  give  an  indication  for  the  section,  one  can 
see  that  fifty  three  (53)  of  the  reported  seventy 
(70)  sections  were  done  for  a number  of  vary- 
ing reasons.  Among  these  were  nineteen  (19) 
for  cephalo-pelvic  disproportion.  It  must  be 
recalled  that  clinical  pelvimetry  and  a trial 
of  labor  are  the  chief  means  by  which  the 
country  doctor  judges  cephalopelvic  dispro- 
portion. No  radiologists  are  available  to  give 
an  x-ray  impression.  The  doctor  usually  has 
a film  of  the  pelvis  for  fetal  detail.  There  are 
eight  (8)  cases  of  placenta  previa.  These,  as 
near  as  can  be  determined  from  the  meager 
physicians’  records,  were  substantiated  at 
surgery.  Seven  (7)  cases  of  transverse  position 
were  a part  of  this  series.  There  were  four 
(4)  cases  of  abruptio  placenta,  one  (1)  of 
which  resulted  in  death  of  fetus  before  birth. 
This  was  apprehended  before  delivery  but 
bleeding  was  the  indication  for  Cesarean  Sec- 
tion. One  (1)  section  reason  is  described  as 
‘elective  premium  baby.’  We  have  this  in  a 
country  series  as  do  our  colleagues  in  the 
city.  Weber  and  Israel  point  out  that  a 
‘valuable  baby’  is  a poor  term  and  a poor  in- 
dication for  abdominal  delivery.  In  their 
series  this  indication  appeared  five  (5)  times 
in  the  first  446  patients  who  were  sectioned. 
It  did  not  occur  in  a later  group  of  554. ''2  We 
trust  that  we  too  will  not  see  it  in  our  forth- 
coming series.  The  three  (3)  cases  of  uterine 
inertia  were  difficult  to  evaluate  from  the 
meager  records  provided.  One  (1)  case  cer- 
tainly had  earmarks  of  the  patient  not  being 
in  true  labor.  We  feel  that  detailed  obstetric 
consultation  would  have  prevented  this.  Re- 
peat Cesarean  Section  was  an  indication  in 
seventeen  (17)  cases.  We  think  most  of  our 
colleagues  in  the  country  feel  that  this  is  a 
valid  indication.  We  do  not  have  unlimited 
quantities  of  blood  immediately  available  in 
case  of  uterine  rupture,  and  we  feel  that  it 
is  safer  to  deliver  the  patient  supravaginally. 


— 79  — 


TABLE  #2 


SOUTH  DAKOTA 


INDICATIONS  FOR  CESAREAN  SECTION  IN 
WINNER.  GREGORY,  AND  BURKE. 
SOUTH  DAKOTA  HOSPITALS 


AGE  PARA  GRAVIDA 

INDICATIONS 

AGE  PARA  GRAVIDA 

INDICATIONS 

40 

4 

5 

Hydatidform  mole,  bleeding 

25 

1 

2 

Pre-eclampsia-severe 

27 

NA* 

NA* 

Dystocia  secondary 
to  cervical  stenosis 

19 

0 

2 

Cephalopelvic  disproportion 

19 

0 

1 

Abruptio  placenta 

17 

0 

1 

Breech 

Cephalopelvic  disproportion 

23 

0 

1 

Cephalopelvic  disproportion 

17 

0 

1 

Cephalopelvic  disproportion 

29 

NA* 

NA* 

Cephalopelvic  disproportion 

35 

1 

2 

Cephalopelvic  disproportion 

17 

0 

1 

Cephalopelvic  disproportion 

28 

1 

2 

Cephalopelvic  disproportion 

15 

0 

1 

Uterine  inertia 

19 

1 

2 

Transverse  presentation 

20 

0 

1 

Cephalopelvic  disproportion 

26 

2 

3 

Cephalopelvic  disproportion 

36 

NA* 

NA* 

Placenta  previa 

38 

NA* 

NA* 

Abruptio  placenta 

19 

0 

1 

Cephalopelvic  disproportion 

38 

1 

4 

Placenta  previa 

19 

0 

1 

Cephalopelvic  disproportion 

23 

0 

1 

Breech 

Cephalopelvic  disproportion 

36 

NA* 

NA* 

Diabetes  mellitus,  suspected 
Cephalopelvic  disproportion 

32 

NA* 

NA* 

Transverse  presentation 

32 

2 

3 

Transverse  position 

33 

NA* 

NA* 

Pre-eclampsia 

36 

3 

4 

Transverse  position 

34 

NA* 

NA* 

Uterine  inertia 

25 

0 

1 

Cephalopelvic  disproportion 

27 

NA* 

NA* 

Cephalopelvic  disproportion 

22 

0 

1 

Placenta  previa 

45 

1 

5 

Placenta  previa 

32 

2 

3 

Pre-eclampsia  with  twins 

23 

3 

4 

Placenta  previa 

24 

0 

1 

Pre-eclampsia 

25 

1 

3 

Transverse  presentation 

22 

0 

1 

Cephalopelvic  disproportion 

37 

2 

3 

Uterine  inertia 

37 

4 

5 

Placenta  previa 

25 

3 

4 

Abruptio  placenta 

25 

3 

4 

Abruptio  placenta 

32 

NA* 

NA* 

NA* 

NA* 

NA* 

NA* 

Cephalopelvic  disproportion 

29 

NA* 

NA* 

NA* 

24 

5 

6 

Placenta  previa 

25 

0 

3 

NA* 

18 

NA* 

NA* 

Cephalopelvic  disproportion 

31 

0 

3 

NA* 

25 

3 

4 

Abruptio  placenta,  lower 
segment  leiomyofibroma 

24 

NA* 

NA* 

Transverse  presentation 

22 

0 

1 

Cephalopelvic  disproportion 

NA*-information  not  available  from  incomplete  hosptial  records. 


— 80  — 


MARCH  1958 


Repeat  Cesarean  Section  in  twenty  three  per- 
cent (23%)  of  our  series  compares  favorably 
with  the  percentage  of  repeat  sections  of 
Weber  and  Israel’s  series  done  in  the  Albert 
Einstein  Medical  Center,  Philadelphia,  Penn- 
sylvania.''2 

Anesthesia  has  been  the  problem  of  great- 
est magnitude  for  the  doctor  in  the  country 
hospital  who  is  faced  with  a Cesarean  Sec- 
tion . In  the  past  if  it  were  an  emergency  for 
placenta  previa,  he  has  asked  the  nurse  to 
give  open  drop  ether.  In  this  series  of  seventy 
(70)  there  are  ten  (10)  cases  of  this  type  anes- 
thesia. Twelve  (12)  cases  were  done  under 
cyclopropane  and  oxygen  anesthesia  with 
eleven  (11)  of  these  patients  receiving  a pen- 
tothal  induction.  In  five  (5)  cases  the  patient 
received  a low  spinal  and  after  the  baby  was 
delivered  was  given  pentothal  and  inhalation 
anesthesia.  This  was  done  in  cases  where  it 
was  felt  that  the  baby  was  not  mature.  By 
way  of  interest  the  greatest  number  of  cases 
were  done  under  low  spinal  anesthesia.  In  all 
of  these  cases  the  spinal  was  given  by  an  M.D. 
and  then  the  following  of  the  patient  was 
turned  over  to  a nurse  helper.  Amazingly 
enough  no  fatalities  followed.  This  procedure 
fortunately  has  changed  now  that  anesthesia 
help  is  available.  One  of  the  other  things  that 
is  changing  this  policy  is  the  preference  of  the 
patient  for  general  anesthesia.  Obviously, 
this  is  not  an  important  factor  when  the 
Cesarean  Section  is  an  emergency  but  in  elec- 
tive sections,  where  the  patient  has  to  be 
considered  in  a discussion  of  anesthesia,  it  is 
a trend  which  we  are  forced  to  follow.  Cer- 
tainly no  doubt  exists  as  to  how  satisfactory 
spinal  anesthesia  is  for  the  doctor  in  the 
country  when  he  is  faced  with  an  emergency 
situation,  a hemorrhagic  situation  being  the 
obvious  exception. 

No  maternal  mortality  was  noted.  Mor- 
bidity was  chiefly  confined  to  the  one  patient 
who  was  diabetic  and  developed  a electrolyte 
imbalance  following  spinal  anesthesia.  In  re- 
viewing the  record  it  was  felt  that  this  could 
have  been  avoided  had  the  hospital  had  its 
technician  to  follow  the  blood  chemistries. 
At  the  time  the  section  was  done  the  tech- 
nician was  not  available.  A post  partum  fever 
was  considered  any  two  successive  elevations 
of- more  than  one  hundred  degrees  (100).  Six- 
teen (16)  patients  showed  elevations.  It  was 
felt  that  all  sixteen  (16)  cases  probably  were 


uterine  in  origin  since  they  all  occured  the 
first  five  (5)  days.  No  uterine  cultures  were 
done  because  at  that  time  none  were  avail- 
able. 

In  all  of  these  hospitals  early  ambulation  is 
practiced.  No  incidence  of  thrombophlebitis 
was  noted.  Elastic  bandages  are  not  used 
routinely  as  a preventative  measure.  No  pa- 
tient received  anticoagulant  therapy. 

Nineteen  (19)  patients  received  blood.  In 
one  of  the  hospitals,  blood  is  given  almost 
routinely.  In  the  other  two  it  is  made  avail- 
able (remembering  that  the  blood  bank  here 
is  a walking  blood  bank)  and  used  if  felt 
needed.  No  transfusion  reactions  either  major 
or  minor  were  noted  as  type  specific  blood  is 
used  as  well  as  type  O of  proper  RH  factor,  to 
which  Witebsky  substances  were  added. 

The  average  hospital  stay  was  seven  and 
two  tenths  days  (7.2),  a total  of  504  hospital 
days.  The  longest  stay  was  thirteen  (13)  days 
and  the  shortest  was  two  (2)  days.  This  pa- 
tient was  transferred  to  a larger  hospital  be- 
cause of  her  diabetes  mellitus  which  had  not 
responded  to  the  treatment  following  spinal 
anesthesia  and  development  of  electrolyte  im- 
balance. 

In  this  series  of  seventy  (70)  sections  with 
delivery  of  seventy  one  (71)  infants  the  fetal 
loss  was  six  (6)  to  give  a eight  and  nine  hun- 
dredths percent  (8.09%).  Three  (3)  of  these 
infants  were  stillborn,  none  of  these  were 
prematures  under  1500  grams,  none  were  ma- 
cerated, and  none  were  anomalous  fetuses. 

If  one  were  to  use  one  of  the  correction  fac-  ^ 
tors  and  remove  stillbirths,  prematures 
under  1500  grams,  macerated  and  anomalous 
fetuses  from  the  series  the  corrected  rate 
could  be  five  and  seven  tenths  percent  (5.7%). 
This  is  greater  than  the  United  States  average 
which  seems  to  be  about  three  percent  (3%). 
The  one  (1)  infant  who  died  more  than  twenty 
four  (24)  hours  after  delivery  had  been  de- 
ivered  under  general  anesthesia.  The  other 
infant  who  died  one  (1)  hour  after  birth  had 
been  delivered  under  low  spinal  anesthesia. 
No  post  mortem  examinations  were  done  so 
nothing  can  be  said  about  any  existing 
anomalies  not  evident  upon  clinical  examina- 
tion. 

Conclusions  from  the  above  preliminary  re- 
port are  as  follows: 

1.  Better  reporting  of  facts  in  the  records  of 
small  hospitals  must  be  done  by  the  doctors 


— 81  — 


SOUTH  DAKOTA 


in  these  hospitals.  This  paper  illustrates  that 
to  critically  review  a series  in  order  to  gain 
self  improvement,  one  must  have  facts.  This 
is  not  impossible.  In  one  of  the  hospitals  very 
adequate  records  are  being  kept.  We  feel  that 
the  others  can  and  will  follow  suit. 

2.  The  need  for  true  obstetric  consultation  is 
obvious.  It  is  felt  that  the  decision  to  do  some 
of  our  sections  could  have  been  changed  by 
a consultation  of  the  obstetric  type.  Perhaps 
obstetricians  are  not  available  but  an  accurate 
and  adequate  obstetric  evaluation  can  be 
made  by  the  consulting  general  physician.  In 
the  hospital  where  this  is  demanded  the 
tendency  to  section  appears  not  to  be  as  great. 

3.  The  anesthesia  problem  is  basic  to  success- 
ful surgery  — Cesarean  Sections  included. 
The  small  hospitals  must  strive  to  gain  better 
anesthesia.  This  can  only  be  done  by  post 
graduate  training  of  its  staff  in  anesthesia 
work.  To  acquire  certified  anesthesiologists 
or  nurse  anesthetists  will  be  a financial  im- 
possibility but  post  graduate  training  of  some 
of  the  hospital’s  key  personnel  can  be  a real- 
ity. The  constant  striving  to  do  better  anes- 
thesia combined  with  refresher  courses  in 
anesthesia  can  raise  the  standard  for  any 
small  hospital.  This  has  happened  in  our  com- 
munity. 

4.  We  feel  that  the  infant  mortality  rate, 
(which  is  obviously  too  high,  8.09%)  will  drop 
proportionately  when  the  anesthesia  methods 
become  more  efficient.  At  present  this  seems 
to  be  the  greatest  reason  to  say  that  Cesarean 
Section  is  not  an  obstetrically  feasible  pro- 
cedure in  the  small  country  hospitals. 

5.  From  the  standpoint  of  maternal  mortality 
and  morbidity,  Sesarean  Section  is  a safe  and 
sound  procedure  in  the  country. 

Summary: 

By  small  country  hospitals  constantly  striv- 
ing to  improve  and  taking  steps  to  make  their 
facilities  and  methods  as  near  like  those  of 
greater  size.  Cesarean  Section  is  an  obstetri- 
cally feasible  procedure. 

REFERENCES 

1.  Allen,  H.  L.,  Weekley,  A.  S.,  and  Metcalf,  D.  W.: 
“Performance  of  Cesarean  Section  With  Aid 
Of  General  Anesthesia,”  Journal  Of  The  Amer- 
ican Medical  Association,  Vol.  164,  1743-1746 
(August)  1957. 

2.  Arnold,  C.  J.  and  McCain,  J.  R.:  “Cesarean  Sec- 
tions at  Grady  Memorial  Hospital  1948-1953”, 
Southern  Medical  Journal,  Vol.  48,  710-717, 
(July)  1955. 


3.  Dodek,  S.  M.,  Friedman,  J.  M.,  Trcichler,  H.  P., 
and  DeCastro,  S.  C.;  “Cesarean  Hysterectomy- 
A Review  Of  Forty  Six  Cases”,  Medical  Annals 
Of  The  District  Of  Columbia,  Vol.  XXII,  235- 
239,  (May)  1953. 

4.  Dyer,  I.,  Nix,  F.  G.,  Weed,  J.  C.,  and  Tyrone, 
C.  H.:  “Total  Hysterctomy  At  Cesarean  Section 
and  In  The  Immediate  Puerperal  Period”, 
American  Journal  Of  Obstetrics  and  Gyne- 
cology, Vol.  65,  517-527,  (March)  1953. 

5.  Falls,  F.  H.:  “A  Comparison  Of  The  Low  Cer- 
vical and  Classical  Cesarean  Section  Opera- 
tions”, American  Journal  Of  Obstetrics  and 
Gynecology,  Vol.  65,  707-719  (April)  1953. 

6.  Greene,  G.  G.:  “Five  Years  Of  Cesarean  Sec- 
tions In  The  Lexington  Hospitals”,  Journal  Of 
Kentucky  Medical  Association,  Vol.  55,  438-442 
(May)  1957. 

7.  Greenhill,  J.  P.:  “Present  Day  Evaluation  Of 
Cesarean  Sections”,  Surgical  Clinics  Of  North 
America,  Vol.  33,  87-100,  (Feb.)  1953. 

8.  Hennessy,  J.  P.:  “A  Report  Of  The  Cesarean 
Sections  Done  In  St.  Vincent’s  Hospital,  New 
York”,  American  Journal  Of  Obstetrics  and 
Gynecology,  Vol.  57,  1167-1185,  (June)  1949. 

9.  Jones,  O.  H.:  “The  Trend  In  Cesarean  Section 
In  Recent  Years”,  American  Journal  Of  Ob- 
stetrics and  Gynecology,  Vol.  66,  747-766,  (Oct.) 
1953. 

10.  McNally,  H.  B.,  and  Fitzpatrick,  V.  P.:  “Pa- 
tients With  Four  Or  More  Cesarean  Sections”, 
Journal  Of  The  American  Medical  Association, 
Vol.  160,  1005-1010,  (March)  1956. 

11.  Schwalenberg,  R.,  Zukowski,  H.  J.,  and  Hoff- 
man, E.  S.:  “A  Critical  Analysis  Of  Seventeen 
Hundred  Cesarean  Section  In  a General  Hos- 
pital”, Grace  Hospital  Bulletin,  Vol.  35,  3-18, 
(Jan.)  1957. 

12.  Weber,  L.,  and  Israel,  J.  L.:  “The  Changing  In- 
dications For  Cesarean  Section”,  Pennsylvania 
Medical  Journal,  Vol.  60,  371-374,  (March)  1957. 

13.  Zettelman,  H.  J.,  and  Bowers,  V.  M.;  “A  Study 
Of  Cesarean  Section  At  Evanston  Hospital 
From  1930-1950”,  American  Journal  Of  Ob- 
stetrics and  Gynecology,  Vol.  65,  953-959,  (May) 
1953. 

14.  Zarou,  G.  S.:  “Analysis  Of  Four  Hundred  Con- 
secutive Cesarean  Actions”,  American  Journal 
Of  Obstetrics  and  Gynecology,  Vol.  63,  122-128, 
(January)  1952. 


ASKWIG  NAMED 
S.  D.  A.C.S.  PRESIDENT 
L.  C.  Askwig,  M.D.,  Pierre,  was  named 
president  of  the  South  Dakota  Chapter  of  the 
American  College  of  Surgeons  at  their  annual 
meeting  in  Huron,  January  18th.  H.  Russell 
Brown,  M.D.,  Watertown,  was  named  secre- 
tary-treasurer. 

The  meeting,  held  just  before  the  medical 
associations’  annual  bad-weather  Council 
meeting,  was  well  attended.  Out-of-state 
guest  speaker  was  C.  R.  Sullivan,  M.D.  of 
the  Mayo  Clinic. 


-82-- 


THE  DIAGNOSIS  AND  TREATMENT  OF 
VAGINAL  BLEEDING  DURING 
PREGNANCY* 

Leonard  P.  Healh,  M.D. 

Detroit,  Michigan 


There  is  probably  no  other  condition  in  the 
female  that  a physician  will  encounter  such 
abnormal  vaginal  bleeding  than  in  pregnancy. 
This  bleeding  may  vary  from  a slight  staining 
to  a catastrophic  hemorrhage  and  thus  direc- 
tly account  for  thirty  to  fifty  per  cent  of  all 
maternal  mortality  and  indirectly  to  a greater 
percentage  since  hemorrhage  is  a contribut- 
ing cause  of  deaths  attributable  to  sepsis. 

Intelligent  pre-natal  care  should  consist  of 
a thorough  evaluation  of  the  patients  past  and 
present  history  as  well  as  a careful  physical 
examination  with  particular  attention  to  the 
pelvic  findings.  The  patient  is  not  only  en- 
titled to  frequent  urinalyses,  blood  pressure 
checks  and  weight  observations  but  she 
should  have  repeated  blood  counts  and  hemo- 
globins at  least  in  each  trimester  or  more  fre- 
quently as  indicated.  The  correction  of 
anemias  and  nutritional  deficiencies  early  in 
the  antenatal  course  will  insure  the  best 
prophylactic  measures  against  serious  con- 
sequences resulting  from  sudden  hemor- 
rhaging during  any  trimester  of  pregnancy, 
or  in  the  immediate  puerperium. 

In  spite  of  the  most  meticulous  precautions 
taken  by  both  patient  and  physician  during 

* Presented  at  the  Sixty  First  Annual  Meeting  of 
the  Sioux  Valley  Medical  Association,  February 
1957,  Sioux  City,  Iowa. 


pregnancy,  vaginal  bleeding  in  various 
amounts  will  occur.  The  bleeding  may  be 
caused  by  conditions  that  existed  prior  to  the 
pregnancy,  or  by  conditions  that  are  result 
of  pregnancy. 

It  is  the  purpose  of  this  paper  to  present 
the  common  causes  of  vaginal  bleeding  in 
each  trimester  of  pregnancy  and  to  discuss 
their  diagnoses  and  treatment. 

In  the  first  trimester  the  bleeding,  inde- 
pendent of  the  pregnancy,  may  be  the  result 
of  lesions  of  the  cervix  such  as  cervical  ero- 
sions, cervical  polyps,  cervical  varices,  car- 
cinoma of  the  cervix,  or  lesions  of  the  vaginal 
canal  such  as  condylomata,  or  inflammatory 
lesions  such  as  trichomoniasis,  moniliasis, 
gonorrhea  and  ulcerations  of  the  vaginal 
mucosa. 

The  bleeding  points  of  cervical  erosions  or 
cervical  varices  during  pregnancy  are  best 
treated  with  local  hemostatics  such  as  oxi- 
dized cellulose  gauze,  or  by  gentle  and  super- 
ficial application  of  the  nasal  tip  electro- 
cautery. Extensive  cauterization  of  the  cer- 
vix should  be  avoided  at  this  time. 

Cervical  polyps  if  causing  bleeding,  may  be 
ligated  as  close  to  their  base  as  possible  and 
then  removed.  Microscopic  sections  of  the 
polyps  should  be  studied  to  rule  out  possible 


— 83  — 


SOUTH  DAKOTA 


malignant  changes. 

The  multipara  between  the  ages  of  thirty 
and  forty  presenting  rather  extensive  areas 
of  cervical  erosion  that  bleed  on  contact, 
should  have  biopsies  of  the  erosion  done  to 
rule  out  cervical  carcinoma.  The  incidence 
of  this  malignancy  in  pregnancy  is  reported 
to  be  about  one  in  three  thousand  to  one  in 
seven  thousand  cases,  and  has  been  found  to 
be  rare  in  primigravida.  Prystowsky  and 
Brack  found  that  abortion  occurs  in  thirty  to 
forty  per  cent  of  the  patients.  The  treatment 
before  viability  of  the  fetus  should  be  by  X- 
Ray  then  radium  in  the  same  manner  as  in 
the  non-pregnant  woman.  If  the  diagnosis  is 
made  after  viability  a classical  cesarean  sec- 
tion is  done  followed  two  weeks  later  by  X- 
ray  then  radium. 

Campos  and  Soihet  warn  of  the  difficulty 
in  diagnosing  a carcinoma  of  the  cervix  in 
situ  during  pregnancy  because  of  the  transi- 
tory histological  changes  in  the  cervix  re- 
sulting from  the  gestation.  Mullen  and  For- 
aker  claim  that  cases  of  intra-epithelial  car- 
cinoma of  the  cervix  during  pregnancy  should 
have  prolonged  follow  up  studies  before  any 
radical  therapy  is  considered. 

Condylomata  of  the  vaginal  vault  can  be 
most  troublesome.  Sometimes  they  may  com- 
pletely fill  the  entire  vaginal  canal  and  an 
attempt  at  their  removal  by  surgical  approach 
may  produce  more  bleeding.  I once  had  a 
seventeen  year  old  primigravida  whose  en- 
tire vaginal  vault  was  so  filled  with  condylo- 
mata that  the  cervix  could  not  be  visualized. 
Dermatological  consultation  advised  the  use 
of  Bistrimate  tablets  (sodium  bismuth  tri- 
glycollamate)  each  410  mg.  size  tablet  being 
equivalent  to  75  mg.  of  elemental  bismuth. 
She  was  started  on  this  medication  in  her 
sixth  month  of  pregnancy  receiving  one 
tablet  orally  three  times  daily  for  three  days, 
then  two  tablets  three  times  daily  after  meals. 
Premature  rupture  of  her  membranes  in  her 
eight  month  was  followed  by  an  uneventful 
labor  and  vaginal  delivery  of  a healthy  five 
pound  nine  ounce  infant.  Inspection  of  the 
vaginal  canal  immediately  after  delivery 
showed  a few  discrete  and  minute  asympto- 
matic condylomata  present. 

A microscopic  study  of  a normal  saline  sus- 
pension of  the  vaginal  discharge  will  confirm 
the  presence  or  absence  of  suspected  tricho- 
monas vaginitis  or  monilia  vaginitis.  In  sus- 


picious cases  a gram  stain  of  the  cervical  and 
urethral  discharge  should  be  done  to  rule 
out  a gonorrheal  vaginitis.  There  are  many 
methods  of  treating  cases  of  trichomoniasis 
and  moniliasis.  Your  favorite  method  used 
in  the  non  pregnant  may  be  employed  in  the 
pregnant  patient,  except  that  no  methods  be 
used  which  employ  the  insertion  of  appli- 
cators into  the  vaginal  canal  because  of  the 
possibility  of  causing  trauma  to  a soft  cervix 
or  interrupting  a pregnancy  by  the  insertion 
of  the  applicator  into  a patulous  cervical 
canal.  In  persistent  cases  of  trichomonas  the 
husband  should  use  a condom  for  coitus  and 
the  patient  may  be  relieved  by  taking  one 
Tritheon  tablet  orally  three  times  daily  for 
ten  days.  Cases  of  monilia  may  warrant  more 
careful  urinalysis  and  even  determination 
of  blood  sugars  to  rule  out  the  possibility  of 
diabetes  mellitus. 

If  gonococci  are  found,  a single  injection 
intramuscularly  of  300,000  units  of  penicillin 
will  produce  a cure.  Repeated  smears  and 
cultures  at  monthly  intervals  for  three  suc- 
cessive negative  reports  should  be  obtained. 

Vaginal  ulcers  are  occasionally  the  result 
of  the  use  of  potassium  permanganate  pills 
that  are  used  by  women  in  an  attempt  to  pro- 
duce an  abortion.  Marsh  and  Webster  in  a 
review  of  128  cases  of  vaginal  hemorrhage 
from  this  chemical,  state  that  in  only  one  of 
these  cases  was  a correct  diagnosis  made  due 
to  the  patients  giving  a false  history.  They 
believe  that  the  diagnosis  should  always  be 
suspected  in  profuse  bright  red  vaginal  bleed- 
ing without  the  passage  of  tissue.  In  this 
series  bleeding  was  so  profuse  that  28%  re- 
quired transfusions  up  to  3000  ccs.  Fifty  per 
cent  of  their  own  twenty  three  cases  required 
suturing  of  the  ulcer  in  order  to  control  the 
bleeding.  They  conclude  that  the  possibility 
of  chemical  burns  of  the  vagina  should  be 
considered  in  the  differential  diagnosis  of  all 
cases  of  bleeding  in  early  pregnancy. 

An  earlier  serologic  test  that  was  negative 
may  be  positive  in  the  presence  of  a vaginal 
ulcer  that  may  be  a chancer.  Antiluetic 
therapy  should  be  started  at  once.  According 
to  a report  to  the  council  on  Pharmacy  and 
chemistry  of  the  A.M.A.  by  Thomas  in  De- 
cember 1956  such  therapy  for  syphilis  in  the 
pregnant  patient  is  the  same  as  in  the  non 
pregnant,  namely  a single  treatment  of  2,400,- 
000  units  of  benzathine  penicillin  G.  Such  a 


— 84  — 


MARCH  1958 


dose  can  be  used  for  the  routine  therapy  of 
early  and  latent  syphilis.  If  procaine  peni- 
cillin G in  oil  and  aluminium  monostearate  is 
used,  routine  therapy  should  consist  of  4,800,- 
000  units  with  individual  injections  of  1,200,- 
000  units  every  two  to  seven  days.  For  those 
allergic  to  penicillin,  Terramycin  or  Aureo- 
mycin  in  doses  of  three  to  four  grams  daily 
given  in  divided  doses  of  0.75  gm  to  1.0  gm 
every  six  hours  for  10  to  12  days. 

The  most  common  cause  of  vaginal  bleed- 
ing due  to  pregnancy  in  the  first  trimester  is 
the  effort  of  the  uterus  to  produce  a spon- 
taneous abortion.  Time  does  not  permit  to 
consider  in  detail  the  many  factors  that  may 
produce  a spontaneous  abortion.  We  are 
aware  however  that  there  are  paternal  and 
fetal  factors,  as  well  as  maternal  factors  ac- 
counting for  a ten  to  twenty  per  cent  term- 
ination of  all  pregnancies. 

Speert  and  Guttmacher  in  a study  of  over 
seven  hundred  private  cases  found  that 
twenty  eight  per  cent  complained  of  vaginal 
bleeding  at  some  time  between  the  twenty 
fifth  and  one  hundred  ninety  sixth  day  of 
gestation  but  abortion  occured  in  only  about 
one  third  of  those  who  spotted  or  bled,  and 
the  other  two  thirds  went  to  viability.  They 
mention  that  implantation  bleeding  must  be 
differentiated  from  bleeding  of  spontaneous 
abortion  emphasizing  that  in  the  former  it 
is  usually  bright  red,  slight  in  amount  and 
usually  not  associated  with  pelvic  cramping. 
Whereas  in  the  latter  the  bleeding  begins  as 
a scant  tan  or  dark  brown  discharge  becom- 
ing progressively  heavier  with  the  passage 
of  clots  and  later  there  is  a regression  of  the 
objective  and  subjective  symptoms  of  preg- 
nancy. 

There  is  no  treatment  for  implantation 
bleeding  and  altho  there  is  no  specific  ther- 
apy for  threatened  spontaneous  abortion  the 
patient  most  desirous  of  retaining  her  preg- 
nancy demands  that  her  physician  perform 
some  miracle  in  order  that  she  may  continue 
her  pregnancy  to  a successful  termination. 

Bed  rest  and  sedation  with  paragoric  or 
codeine  are  probably  as  effective  measures 
as  the  many  others  suggested  by  numerous 
enthusiastic  investigators  who  have  used  the 
following  separate  or  in  combination:  anti- 
histamines, natural  and  synthetic  estrogens, 
oral  and  injectable  progesterones  and  vita- 
mines. 


Turnbull  and  Walker  state  that  they  doubt 
whether  any  form  of  treatment  can  repair 
damage  to  the  decidual  placental  site  occur- 
ring at  the  time  of  threatened  abortion,  but 
suggest  that  blood  loss  and  the  extent  of 
damage  may  be  limited  by  adequate  rest  in 
bed  and  attention  to  the  state  of  health  of 
the  individual  throughout  her  pregnancy 
with  particular  emphasis  on  a well  balanced 
diet  especially  in  the  mal-nourished  patient. 
They  also  advocate  bed  rest  from  the  thirty 
fourth  week  in  the  patient  who  has  had 
bleeding  repeatedly  or  the  patient  who  has  a 
history  of  previous  abortion  or  premature 
delivery. 

Javert  has  done  extensive  investigation  in 
the  treatment  of  the  habitual  aborter  and  has 
been  able  to  bring  a group  of  two  hundred 
patients  to  an  84%  successful  outcome.  He 
attempts  with  preconceptional  consultation 
of  both  husband  and  wife  to  correct  specific 
medical,  gynecological,  dental,  mental  and 
psychologic  factors.  Early  and  frequent  pre- 
natal visists  are  insisted  upon  and  an  ade- 
quate diet  with  a plentiful  supply  of  citrus 
fruits  is  emphasized  in  addition  to  the  pre- 
scribing of  additional  supplements  of  vitamin 
C,  P and  K.  If  there  is  a minus  basal  meta- 
bolism thyroid  extract  is  used.  In  stressing 
the  phychosomatic  element  of  the  case  of  the 
habitual  aborter,  Javert  emphasizes  the  per- 
mission of  unlimited  phone  calls  by  the  pa- 
tient and  providing  the  patient  an  opportun- 
ity for  a casual  meeting  in  his  reception  room 
with  a former  successfully  treated  habitual 
aborter.  He  approves  of  bed  rest  only  for  the 
case  of  threatened  abortion,  and  does  not  per- 
mit the  use  of  sex  hormones,  vitamin  E,  min- 
eral oil,  or  tight  abdominal  girdles.  Complete 
sexual  abstinence  is  advised  throughout  the 
entire  pregnancy. 

If  the  patient  persists  in  having  a progres- 
sion in  bleeding  and  cramping,  hospitalization 
will  be  required  for  examination  under  anes- 
thesia and  necessary  blood  replacement  along 
with  a currettage  of  the  uterus.  This  proce- 
dure is  only  to  be  done  in  the  absence  of  a 
moderately  elevated  temperature,  and  only 
after  a blood  count  has  been  done  and  com- 
patible blood  is  ready  for  use.  Occasionally 
intra-uterine  packing  may  be  indicated  fol- 
lowing the  currettage,  however  if  intraven- 
ous erogorate  is  given  after  the  removal  of 


— 85  — 


the  retained  products  of  conception,  resort  to 
utero-vaginal  tamponade  will  not  be  neces- 
sary. 

Unruptured  tubal  pregnancy  can  produce 
symptoms  similar  to  threatened  abortion  and 
should  always  be  considered  as  a possible 
cause  of  bleeding  in  the  first  trimester.  The 
diagnosis  is  difficult  in  comparison  to  the 
easily  diagnosed  case  of  a ruptured  tubal 
pregnancy.  If  one  is  always  ectopic  concious 
the  chances  will  always  be  greater  that  a 
tubal  pregnancy  will  not  be  forgotten.  A pa- 
tient in  the  child  bearing  age  with  irregular 
vaginal  bleeding  and  complaining  of  lower 
abdominal  pain  discomfort  varying  in  inten- 
sity from  a soreness  or  nagging  pain  to  a sud- 
den severe  pain  in  one  or  both  lower  quad- 
rants should  be  considered  as  a possible  case 
of  tubal  pregnancy.  A history  of  a missed 
period  is  not  essential  to  clinch  the  diagnosis 
for  in  a large  series  of  reported  cases  more 
than  fifty  per  cent  of  these  cases  had  no 
amenorrhea. 

In  a study  of  300  cases  of  tubal  pregnancies, 
Crawford  and  Hutchinson  found  that  only 
seven  per  cent  followed  a text  book  pattern. 

In  another  study  of  382  tubal  pregnancies. 
Word  found  that  the  usual  sequences  of 
symptoms  was  abdominal  pain  followed  by 
vaginal  spotting  or  bleeding  and  a history  of 
a change  in  the  menstrual  pattern  with 
oligomenorrhea,  or  amenorrhea  varying  from 
a few  days  to  as  much  as  three  months. 

The  death  rate  of  tubal  pregnancy  is  still 
too  high  being  between  four  and  five  per 
100,000  live  births  throughout  the  United 
States.  This  rate  can  only  be  reduced  if  phys- 
icians will  always  be  ectopic  conscious  and 
will  resort  to  needling  of  the  posterior  cul-de- 
sac  of  Douglas.  If  non-clotted  blood  is  ob- 
tained an  exploratory  operation  of  the  abdo- 
men and  pelvis  is  done  with  removal  of  the 
effected  tube.  Blood  replacement  at  least  be- 
fore and  during  the  operation  procedure  is 
also  important  and  necessary  in  saving  the 
patients  life.  Transfusions  may  be  needed 
after  the  completion  of  the  operation.  Ad- 
ditional surgery  such  as  appendectomy 
should  not  be  done  in  the  patient  who  has 
recently  been  in  acute  shock  from  a ruptured 
tubal  pregnancy. 

Occasionally  the  physician  has  a patient 
who  in  the  first  or  second  trimester  has  had 
vaginal  bleeding  with  cramping  suggestive 


SOUTH  DAKOTA 
of  a threatened  abortion.  These  symptoms 
cease  spontaneously  or  the  physician  believes 
that  he  has  successfully  treated  the  patient 
only  to  find  that  a few  weeks  later  all  sub- 
jective signs  of  pregnancy  have  diminished 
and  upon  careful  pelvic  examination  there 
has  been  no  further  progress  in  the  growth  of 
the  uterus.  A condition  of  missed  abortion 
exists.  As  a rule  these  patients  will  event- 
ually abort  spontaneously,  however  in  a few 
there  will  be  a decrease  in  plasma  fibrinogen. 
Ratnoff  found  that  8 out  of  31  cases  that 
had  a retained  dead  fetus  showed  hypofi- 
brinogenenia.  This  decrease  below  the  nor- 
mal limits  of  fibrinogen  was  not  reported  in 
cases  in  which  the  fetal  death  occurred  earlier 
than  the  fourth  month  of  pregnancy  or  noted 
less  than  five  weeks  after  the  apparent  death 
of  the  fetus.  Ratnoff  believes  also  that  pa- 
tients with  a retained  dead  fetus  should  re- 
port any  evidence  of  bleeding  and  even  in  the 
absence  of  bleeding  symptoms,  should  have  ' 
weekly  determinations  of  their  plasma  fi- 
brinogen concentrations  beginning  the  third 
week  after  the  diagnosis  of  fetal  death. 
Greenhill  and  also  Kinch  concur  in  these 
opinions.  Ratnoff  advises  that  four  grams  of 
fibrinogen  be  given  intravenously  and  re- 
peated at  intervals  in  order  to  raise  the  fi- 
brinogen to  normal  levels  and  when  such  is 
accomplished  then  the  uterus  should  be 
emptied.  He  found  that  with  spontaneous  or  | 
induced  labor  there  was  no  significant 
changes  in  plasma  fibrinogen  concentrations 
in  twelve  patients  who  had  a retained  dead 
fetus  three  to  eleven  weeks  previously,  and 
the  hypofibrinogenemia  was  corrected  I 
promptly  by  emptying  the  uterus. 

Vaginal  bleeding  occurring  during  the  first 
two  trimesters  of  pregnancy  may  in  about 
one  out  of  every  1200  to  2000  pregnancies  be 
due  to  a hydatidiform  mole.  This  bleeding  | 
is  usually  characterized  by  a prolonged  I 
seepage,  for  weeks  or  months,  of  a dark  red  I 
or  brown  discharge.  The  characteristic  clear  | 
grape  like  vesicles  may  be  passed  separately  j 
or  found  within  the  blood  clots.  In  about  I 
thirty-five  to  fifty  per  cent  of  molar  preg-  ^ 
nancies,  the  uterus  is  larger  than  the  corres- 
ponding period  of  amenorrhea.  In  about 
twenty  per  cent  of  the  cases,  the  appearance 
in  the  first  or  second  trimester  of  album- 
inuria, hypertension,  edema  and  eye  sym- 
ptoms are  found  in  this  order  of  frequency 
according  to  Alter  and  Cosgrove.  The  ab- 


I 


— 86  — 


MARCH  1958 


sence  of  fetal  parts  on  X-ray  in  a patient 
with  five  to  six  months  gestation  will  be  of 
diagnostic  assistance. 

Eastman  believes  that  a biologic  test  for 
chorionic  gonadotrophin  may  be  the  decisive 
factor  in  the  diagnosis  of  a hydatidiform  mole. 

In  his  clinic  he  has  found  assays  of  the  serum 
of  the  patient  using  the  immature  rat  uterine 
weight  method  to  be  the  most  accurate  after 
the  first  100  days  of  pregnancy.  In  doubtful 
cases  he  recommends  one  or  more  repeat 
assays  at  weekly  intervals. 

The  treatment  of  hydatidiform  mole  is 
immediate  evacuation  of  its  contents  from 
the  uterus  after  the  necessary  blood  replace- 
ments. Since  this  can  be  a treacherous  pro- 
cedure both  from  the  possibility  of  profuse 
hemorrhaging  and  the  perforation  of  the 
uterus,  pitocin  stimulation  to  aid  in  the  spon- 
taneous evacuation  should  be  first  attempted 
if  bleeding  is  not  too  active.  A currettage  is 
then  done  a few  days  later  when  the  uterus 
has  had  a chance  to  begin  involution.  If  in- 
fection is  present  this  should  be  controlled 
by  antibiotics  and,  or,  chemotherapy  before 
active  intervention  in  a case  that  is  not  bleed- 
ing profusely.  Vaginal  hysterotomy  may  be 
necessary  for  the  evacuation  of  the  mole  in 
the  larger  uterus  and  if  the  abdominal  ap- 
proach is  necessary  serious  consideration  is 
given  to  a hysterectomy  in  the  multiparous 
patient  or  the  patient  who  is  forty  years  of 
age  or  older.  All  cases  that  have  had  the 
uterus  emptied  of  the  mole  should  be  fol- 
lowed with  quantitative  assays  of  chorionic 
gonadotrophin  at  least  every  two  weeks  until 
the  result  is  negative,  and  then  every  month 
for  one  year. 

Any  abnormal  vaginal  bleeding  that  in- 
tervenes anytime  after  the  mole  has  been 
evacuated,  should  warrant  immediate  hos- 
pitalization for  a diagnostic  currettage  of  the 
uterus  and  a repeat  assay  of  chorionic  gona- 
dotrophin in  order  to  detect  the  possibility  of 
the  presence  of  a choriocarcinoma.  About  one 
to  two  per  cent  of  all  patients  having  molar 
pregnancies  will  subsequently  develop  a 
choriocarcinoma. 

Towards  the  end  of  the  second  trimester 
and  anytime  in  the  third  trimester,  placenta 
previa,  placenta  abruptio,  marginal  sinus 
bleeding,  and  circumvallate  placentae  can  all 
be  considered  as  important  and  serious  causes 
of  vaginal  bleeding.  They  must  of  course  be 

— 87 

k 


differentiated  from  other  causes  of  bleeding 
existing  prior  to  and  independent  of  preg- 
nancy; all  of  which  were  mentioned  in  the 
preceding  paragraphs. 

The  incidence  of  placenta  previa  as  re- 
ported by  large  series  of  cases  varies  from 
0.32  to  2 per  cent,  or  the  occurrence  is  about 
1 in  every  150  to  300  deliveries  being  found 
more  in  multipara  than  in  primipara.  The 
diagnosis  is  dependent  on  X-ray  after  the 
thirty  second  week  and  vaginal  examination. 
Soft  tissue  roentgenography  for  the  localiza- 
tion of  the  placenta  is  the  X-ray  method  of 
choice.  Placenta  previa  can  be  diagnosed 
when  the  shadow  of  the  placenta  cannot  be 
seen  in  the  upper  uterine  segment  on  the 
lateral  and  oblique  films  of  the  abdomen,  or 
the  shadow  is  found  to  disappear  into  the 
pelvis  and  also  there  is  found  to  be  a displace- 
ment of  the  fetal  skull  or  presenting  part  in 
the  erect  lateral  film  of  the  pelvis.  Deferring 
vaginal  examinations  until  after  X-rays  have 
been  evaluated  saves  the  patient  blood. 

In  all  suspected  cases  of  placenta  previa, 
the  initial  bleeding  is  never  exsanguinating 
clear  but  if  an  attempt  is  made  at  vaginal  or 
rectal  examinations  prior  to  proper  prepara- 
tion of  the  patient,  sudden  uncontrollable 
hemorrhage  can  occur.  At  least  two  pints  of 
compatible  blood  should  be  available  and  a 
functioning  venoclysis  with  an  eighteen  guage 
needle  should  have  been  started  prior  to  a 
most  gentle  and  sterile  vaginal  examination 
in  a delivery  or  operating  room  that  has  been 
prepared  for  either  a vaginal  or  abdominal 
delivery.  Vaginal  examination  should  be 
postponed  if  the  X-ray  findings  are  positive 
or  if  the  bleeding  has  subsided,  particularly 
in  cases  suspected  of  having  non  viable  pre- 
matures or  infants  who  are  of  questionable 
size  or  who  have  not  reached  maturity  as 
evidenced  by  failure  to  demonstrate  the  ap- 
pearance of  the  distal  femoral  epiphyses  of 
the  fetus  on  the  X-ray  films.  Since  some 
studies  have  shown  symptoms  to  occur  before 
viability  in  from  seven  to  twenty  five  per 
cent  of  the  cases  of  placenta  previa  and  from 
thirty  to  eighty  per  cent  of  cases  show  sym- 
ptoms before  term,  expectancy  and  intelligent 
inactivity  are  in  order. 

Conservative  management  ends  according 
to  Schmitz  and  others,  when  the  patient  has 
ante-partum  hemorrhage  between  the  thirty- 
seventh  week  and  term,  or  in  patients  who 


SOUTH  DAKOTA 


have  been  under  expectant  treatment  and 
have  reached  the  thirty  eighth  week,  and  in 
cases  where  there  is  present  more  than  a 
moderate  hemorrhage  or  when  the  bleeding 
persists  for  hours.  These  investigators  believe 
that  vaginal  examination  when  possible 
should  be  deferred  until  termination  of  preg- 
nancy is  decided  upon. 

The  method  of  delivery  will  be  dependent 
upon  the  location  of  the  placenta.  Cesarean 
section  is  the  procedure  of  choice  for  those 
cases  of  total  placenta  previa  and  those  cases 
with  an  undilated  cervix,  regardless  of  parity, 
and  for  those  cases  with  mal-presentation.  In 
a case  with  a soft  dilatable  and  partially 
effaced  cervix  in  a multipara  or  primipara 
in  labor,  with  a low  lying  or  partial  placenta 
previa  and  with  the  presenting  part  engaged 
in  the  pelvis,  the  membranes  can  be  ruptured 
and  vaginal  delivery  anticipated.  As  Green- 
hill  emphasizes  there  are  only  two  methods 
of  treatment  for  placenta  previa,  (1)  rupture 
of  the  membranes,  or  (2)  Cesarean  section. 
He  as  well  as  Kern  and  Roddie  are  opposed 
to  the  use  of  bags  and  Braxton  Hicks  version. 

Since  about  only  thirty  three  per  cent  of 
all  cases  of  painless  vaginal  bleeding  in  the 
third  trimester  are  due  to  placenta  previa, 
other  sources  of  vaginal  bleeding  due  to  preg- 
nancy must  be  sought  for. 

When  placenta  previa  has  been  definitely 
ruled  out  by  X-ray  and  vaginal  examination, 
rupture  of  a marginal  sinus  of  the  placenta 
should  be  considered  as  a possible  cause  of 
the  painless  bleeding.  The  diagnosis  can  only 
be  confirmed  after  delivery  of  the  placenta 
but  prior  to  completion  of  the  third  stage, 
such  symptoms  as  bright  red  vaginal  bleed- 
ing just  prior  to  term  should  make  one  sus- 
picious of  a ruptured  marginal  placental 
sinus.  The  vaginal  bleeding  does  not  recur 
as  often  as  in  placenta  previa  but  when  it 
does  there  are  concomitant  symptoms  of 
labor  such  as  uterine  contractions  and  uterine 
irritability. 

The  proof  of  a rupture  of  the  marginal  sinus 
of  the  placenta  will  be  dependent  upon  the 
demonstration  according  to  Fish  of  a clot 
of  old  or  recent  formation  adherent  to  a por- 
tion of  the  placental  margin,  overlying  a 
tear  in  the  marginal  sinus  and  spreading  out 
over  the  adjacent  membrane,  and  occasion- 
ally covering  a narrow  portion  of  the  mater- 
nal surface  of  the  marginal  cotyledons. 


Ferguson  states  that  the  clot  averages  50 
to  100  cc.  at  the  margin  and  is  usally  not  large 
and  does  not  appear  interposed  between  the 
placental  and  the  uterus.  The  clot  does  not 
indent  or  discolor  the  maternal  surface  of  the 
placenta,  nor  does  it  alter  the  texture  of,  or  is 
it  adherent  to,  the  maternal  surface. 

In  a study  of  ninety  seven  cases  of  hemor- 
rhage in  late  pregnancy  occurring  within  a 
six  month  period  of  2,251  deliveries,  Ferguson 
found  rupture  of  the  marginal  sinus  of  the 
normally  implanted  placenta  in  303  cases  or 
34%.  All  patients  were  delivered  vaginally 
but  when  there  is  doubt  as  to  the  diffenen- 
tiation  between  rupture  of  the  marginal  sinus 
and  abruption  of  the  placenta,  he  believes 
management  should  be  conducted  in  favor  of 
abruption. 

Circumvallate  placenta,  like  rupture  of  the 
marginal  sinus  of  the  placenta,  cannot  be 
definitely  diagnosed  until  after  completion 
of  the  third  stage  of  labor.  Eastman  in  his 
latest  text  considers  it  as  an  “interesting  ab- 
normality” without  any  marked  effect  on  the 
pregnancy  or  course  of  labor.  Gainey  and 
Nicolay  find  the  incidence  of  this  type  of 
placenta  to  be  1 in  188  to  208  deliveries,  ac- 
companied by  a high  fetal  loss  and  associated 
with  high  incidence  of  late  abortions  pre- 
mature labors  and  maternal  hemorrhage. 
Hunt  and  Mussey  believe  that  in  50%  of  the 
cases  there  is  a similarity  to  the  symptoms  of 
placenta  previa  or  premature  separation  of 
the  placenta.  They  believe  the  common  sym- 
ptoms of  circumvallate  placenta  to  show  fre- 
quent recurrence  or  no  subsidence  of  vaginal 
bleeding  even  from  the  first  or  second  tri- 
mester, and  also  early  rupture  of  the  mem- 
branes with  hydrorrhea  followed  usually  by 
premature  labor.  As  in  rupture  of  the  mar- 
ginal sinus  of  the  placenta,  expectancy  and 
bed  rest  are  the  principles  in  management  of 
bleeding  from  a circumvallate  placenta  plus 
the  use  of  antibiotics  due  to  hydrorrhea  and  a 
premature  rupture  of  the  membranes,  and  the 
differentiation  from  placenta  previa  and 
placenta  abruptio. 

Of  all  the  causes  of  vaginal  bleeding  in  the 
last  trimester,  placenta  abruptio  when  pres- 
ent should  give  the  attending  physician  the 
greatest  concern  for  the  outcome  of  both 
mother  and  child.  Fortunately,  complete 
separation  of  the  placenta  is  rare  occurring 
about  one  in  every  five  hundred  pregnancies. 


— 88  — 


MARCH  1958 


but  various  degrees  of  partial  separations;  in- 
volving from  one  quarter  to  one  half  of  the 
placenta,  occur  in  about  one  in  eighty  to  two 
hundred  and  fifty  pregnancies. 

Placenta  abruptio  should  be  suspected  in 
patients  with  toxemia,  twins,  those  with  pre- 
vious Cesarean  sections  and  those  who  have 
uterine  fibroids.  The  dark  vaginal  bleeding 
is  accompanied  by  or  preceded  by  abdominal 
pain  with  a hypertonic  uterus  in  contrast  to 
the  painless  type  of  bright  red  bleeding  with 
a uterus  of  normal  tonicity  in  placenta  pre- 
via. The  bleeding  in  abruptio  at  first  is  much 
more  profuse  than  the  initial  bleeding  in  pre- 
via. There  may  be  a defective  clotting  of  the 
blood  in  the  patient  with  abruptio.  Kench 
believes  the  classification  of  placenta  abrup- 
tion is  not  as  toxemic  or  non  toxemic  but  as 
normal  or  abnormal  clotting  types. 

Hypofibrinogenemia  or  afibrinogenemia 
should  always  be  observed  for  in  all  cases  of 
abruptio.  Five  cc.s  of  venous  blood  is  placed 
in  a test  tube,  and  its  tendency  to  clot  is  noted 
within  a few  minutes  and  then  it  is  observed 
again  after  being  incubated  for  one  hour  at 
37°C.  Partial  to  complete  dissolution  of  the 
clot  will  appear  according  to  the  reduction  of 
the  fibrinogen  concentration  in  the  blood. 
This  test  is  done  at  hourly  intervals  until  the 
patient  is  delivered.  Fibrinogen  loss  is  best 
corrected  first  by  the  administration  of  fresh 
citrated  whole  blood,  lOOOcc.s  being  capable 
of  furnishing  about  1.5  to  2.0  gm.  of  fibrino- 
gen. If  clotting  does  not  improve  with  fresh 
citrated  blood,  then  2 to  4 gms.  of  purified 
human  fibrinogen  dissolved  in  10%  glusose 
solution  may  be  given  intravenously.  No  at- 
tempt at  delivery  should  be  done  until  the 
clotting  mechanism  has  been  restored. 

Following  blood  replacement  and  correc- 
tion, if  necessary,  of  the  coagulation  defect, 
emptying  of  the  uterus  is  next  to  be  con- 
sidered. A sterile  vaginal  examination  is 
done  with  the  same  precautions  and  prepara- 
tions as  for  diagnosis  of  a placenta  previa.  If 
no  central  previa  is  found  rupture  of  the 
membranes  is  done  and  vaginal  delivery 
awaited  in  the  case  of  the  patient  who  has 
persistent  bleeding  without  fetal  distress  and 
with  no  uterine  tetany.  If  labor  does  not  en- 
sue within  two  hours  then  Cesarean  section 
should  be  done. 

In  the  case  of  a primigravida  with  abdom- 
inal tenderness,  uterine  tetany,  and  fetal 


heart  tones  present  but  no  coagulation  defect, 
then  Cesarean  section  is  the  method  of  choice 
for  delivery. 

In  the  case  of  a multipara  not  in  shock  with 
a dead  fetus  and  no  uterine  tetany  rupture 
the  membranes  and  await  vaginal  delivery 
but  if  bleeding  continues  and  there  is  no 
progress  then  Cesarean  section  should  be 
done. 

If  a primigravida  or  a multipara  is  in  shock 
plus  uterine  tetany  and  a dead  infant,  rup- 
ture of  the  membranes  may  be  done  follow- 
ing fibrinogen  restoration  with  blood  replace- 
ment and  intravenous  fibrinogen  if  necessary. 

In  a study  of  104  cases  of  premature  separa- 
tion at  the  University  of  Iowa,  Eadie  and 
Randall  found  an  incidence  of  Cesarean  sec- 
tion to  be  only  3.7  per  cent  and  advocated  this 
type  of  delivery  in  the  following  conditions, 
(1)  after  rupture  of  the  membranes  and  pit- 
uitary stimulation  failed  to  contract  the 
uterus,  (2)  fetal  distress,  (3)  failure  of  the 
cervix  to  dilate  and  (4)  when  bleeding  tend- 
ency results  from  afibrinogenemia.  They 
concluded  that  89.6%  of  the  cases  of  abruptio 
placenta  could  be  delivered  vaginally  with 
relative  safety  to  the  mother  and  that  the 
fetal  mortality  was  similar  to  that  in  series 
in  which  Cesarean  section  was  the  most  com- 
mon method  of  delivery. 

Attempt,  therefore,  at  vaginal  delivery,  in 
absence  of  fetal  distress,  should  be  done  when 
possible  after  correction  of  the  fibrinogen 
concentration.  Rupture  of  the  membranes  is 
done  regardless  of  length,  softness  or  dilata- 
tion of  the  cervix.  Greenhill  believes  that 
pituitary  preparations  to  aid  labor  should  be 
given  cautiously,  whereas  Page  believes  that 
the  use  of  such  drug  is  contra-indicated  since 
it  may  by  producing  increase  intra-uterine 
pressure  tend  to  promote  an  increase  hypo- 
fibrinogenemia by  the  auto-injection  intra- 
veneously  of  thromboplastin  from  the  tissue 
extracts. 

Douglas  and  co-workers  believe  that  de- 
livery within  four  to  six  hours  after  separa- 
tion would  tend  to  decrease  fetal  mortality 
and  also  decrease  the  maternal  complications 
of  hypofibrinogenemia  and  renal  cortical 
necrosis. 

SUMMARY 

In  summary  then,  the  causes  of  vaginal 
bleeding  during  pregnancy  have  been  pre- 
sented and  their  management  discussed,  prin- 


— 89  — 


SOUTH  DAKOTA 


cipally  as  a review  to  re-alert  the  physician 
to  all  the  possibilities  that  may  predispose  to 
a serious  or  fatal  outcome  of  pregnancy. 

The  hemoglobinometer,  and  the  hemacyto- 
meter have  just  as  important  roles  in  pre- 
natal care  as  the  weight  scale,  the  sphygmo- 
manometer and  the  test  tube  for  urinalyses. 

Frequent  determinations  of  the  patients 
hemoglobin  and  total  red  cells,  and  the  im- 
mediate correction  of  anemias  will  provide 
the  best  defense  against  persistent  or  sudden 
blood  loss  and  afford  the  best  chances  for  re- 
covery and  survival  of  the  mother. 

Blood  loss  must  be  replaced  with  blood. 
The  ready  availability  of  blood  today  in  all 
hospitals  or  Red  Cross  Blood  Banks  is  no  ex- 
cuse for  carelessness  in  the  attempt  to  pro- 
vide every  possible  means  to  conserve  blood. 

At  the  present  time  there  are  no  specific 
measures  that  will  insure  the  completion  of  a 
pregnancy  to  viability  once  that  pregnancy 
has  threatened  to  abort.  The  numerous  re- 
ported successful  results  with  endocrines  hor- 
mones and,  or,  vitamins  may  be  due  to  their 
use  in  cases  of  implantation  bleeding  that 
would  have  terminated  successfully  in  spite 
of  treatment. 

The  patient  who  has  previously  aborted 
may  be  carried  to  successful  termination  in  a 
future  gestation  if  before  conception  takes 
place  she  and  her  husband  have  been 
thoroughly  evaluated  and  all  possible  patho- 
logic and  psychologic  factors  have  been  cor- 
rected and  constantly  observed.  Sexual  ab- 
stinence and  the  avoidance  of  all  stress  fac- 
tors may  prove  to  be  just  as  efficacious  as  the 
prophylactic  use  of  various  endocrine,  hor- 
mone, and  vitamin  preparations. 

Vaginal  examination  in  a bleeding  case  in 
the  first  trimester  should  not  be  deferred  be- 
cause of  the  fear  of  producing  an  impending 
abortion  since  a case  of  ectopic  pregnancy 
might  go  undiagnosed.  Needling  of  the  pos- 
terior cul-de-sac  of  Douglas  may  be  neces- 
sary to  substantiate  a diagnosis  of  an  ectopic 
pregnancy. 

In  the  case  of  missed  abortion  after  the 
twentieth  week  or  a case  of  intra-uterine 
death  over  five  weeks,  coagulation  defects 
should  be  observed  for  and  the  fibrinogen 
levels  restored  with  fresh  whole  blood  and  or 
intravenous  fibrinogen. 

Suspected  cases  of  placenta  previa  should 
have  the  benefit  of  placentography  when  pos- 


sible. If  bleeding  persists  or  recurs  vaginal 
examination  should  be  done  only  after  com- 
patible blood  has  been  made  available  for  the 
patient  who  then  is  examined  in  a delivery 
or  operating  room  that  is  in  readiness  for 
either  a vaginal  or  abdominal  delivery. 

Frequent  observations  of  blood  clotting  in 
cases  of  abruptio  placenta  will  provide  an  in- 
dex for  the  need  of  more  fresh  blood  and  or 
fibrinogen  administration. 

It  is  fortunate  for  all  of  us  in  private  prac- 
tice that  we  do  not  encounter  too  frequently 
placenta  abruptio  or  placenta  previa.  To  re- 
duce maternal  mortality  resulting  from  these 
serious  complications  as  well  as  other  causes 
of  vaginal  bleeding  during  pregnancy  we 
should,  when  faced  with  these  complications, 
frequently  discuss  them  with  our  colleagues. 
Periodic  reviews  of  these  cases  in  staff  con- 
ferences and  thorough  analysis  of  the  fatal 
cases  studied  in  maternal  mortality  commit- 
tees will  prove  of  inestimable  value  both  to 
the  individual  physician  and  to  the  resident 
staff  of  each  hospital. 


REFERENCES 

1.  Campos,  J.,  and  Soihet  S.; 

Surg.,  Gynec.  & Obst.  102;  427,  1956 

2.  Crawford,  E.,  and  Hutckinson,  H.; 

Am.  J.  Obst.  & Gynec.  8;  627,  1956 

3.  Douglas,  R.  G.,  Buckman,  M.  I.,  and  Mac- 

Donald, F.  A.  J.  Obst.  & Gync. 

Brit.  Emp.  62;  710,  1955 

4.  Eadie,  F.  S.  and  Randall,  J.  H.; 

Obst.  & Gynec.  3;  11,  1954 

5.  Eastman,  N.  J.  Williams  Obstetrics  ed  11, 

New  York,  1956 
Appleton-Century-Crofts,  Inc. 

6.  Ferguson,  J.  H.;  New  England  J.  Med.  254; 

645,  1956 

7.  Fish,  J.  S.;  Hemorrhage  of  Late  Pregnancy 

Springfield,  Illinois,  1955  Chas.  C.  Thomas 

8.  Gainey,  H.  L.,  and  Nicolay,  K.  S.; 

Missouri  Med.  51;  986,  1954 

9.  Greenhill,  J.  P.  Obstetrics  ed  11,  Philadelphia 

1955,  W.  B.  Saunders  Co. 

10.  Greenhill,  J.  P.  Year  Book  Obstetrics  & Gyne- 

cology 

1956-1957  Series;  33  217 

Chicago,  The  Year  Book  Publishers,  Inc. 

11.  Hunt,  A.  B.  Mussey,  R.  D.  and  Faber,  J.  E.; 

New  Orleans  Med.  & Surg.  J.  100:  203,  1947 

12.  Javert,  C.  T.  Bull  Margaret  Hague  Maternity 

Hosp.  9:  1,  1956 

13.  Kern,  F.  M.;  Surg.  Clin.  N.  A.  34:  1523,  1954 

14.  Kinch,  R.  A.  H.:  Am.  J.  Obst.  & Gynec.  71:  746, 

1956 

15.  Marsh,  S.  Jr.,  and  Webster,  A.:  Obst.  & Gynec. 

3:  169  1954 

16.  Mullen,  S.  A.  and  Foraker,  A.  G.:  Obst.  & 

Gynec.  2:  274,  1954 

17.  Page,  E.  W.,  King,  E.  B.,  and  Merrill,  J.  A.: 

Obst.  & Gynec.  3:  385,  1954 

18.  Prystowsky,  H.,  and  Brack,  C.  B.: 

Obst.  & Gynec.  7:  522,  1956 

(Continued  on  Page  106) 


— 90  — 


ANESTHESIOLOGY* 


I.  HISTORICAL  BACKGROUND 
Adam's  Rib 

The  first  record  of  a human  being’s  receiv- 
ing some  form  of  anesthetic  during  a painful 
procedure  is  in  the  Bible,  Genesis  11:21:  “And 
the  Lord  God  caused  a deep  sleep  to  fall  on 
Adam,  and  he  slept;  and  he  took  one  of  his 
ribs,  and  closed  up  the  flesh  instead  thereof.” 
Adam  lost  a rib  and  gained  Eve. 

The  people  of  ancient  times  knew  of  the 
pain-relieving  properties  of  various  herbs, 
rocks,  and  wine,  and  the  effect  of  some  forms 
of  hypnotism  and  “laying  on  of  hands.”  Egyp- 
tians, Chinese,  Greeks  and  Romans  employed 
wine  with  hemp,  popy  juice  and  mandrake. 
The  Egyptians  used  ground  rocks  from  Mem- 
phis mixed  with  sour  wine.  (This  is  the 
earliest  records  of  the  use  of  carbonic  acid.) 
Helen  of  Troy  cast  a “drug”  into  wine  to 
“assuage  suffering,  dispel  anger,  and  to  cause 
forgetfulness  of  all  ills.” 

The  "Soporific  Sponge" 

In  Europe  in  the  Middle  Ages  it  was  con- 
sidered immoral  to  try  to  prevent  suffering, 
since  suffering  was  a condition  supposedly 
visited  upon  humanity  by  God  as  punishment 
for  sin.  Use  of  inhalants  for  anesthesia  was 
described  as  “criminal.”  Nevertheless,  from 
the  Eighth  Century  on,  various  mixtures  were 
soaked  up  by  a sponge  (the  “soporific 
sponge”),  the  vapor  breather  by  the  patient 
who  was  later  revived  with  another  sponge 
soaked  with  vinegar. 

Sometimes  the  soporific  sponge  had  bad 
effects  — the  patient  was  asphyxiated.  To 

* Courtesy  of  the  Schering  Corporation 


make  limbs  more  insensitive  to  all  kinds  of 
surgery,  compression  was  frequently  used, 
i.e.,  pressure  on  nerves  and  blood  vessels. 
Sometimes  the  results  were  disastrous.  Even 
blood-letting  to  the  point  of  insensibility  had 
its  advocates  and  users. 

Ether 

Sweet  vitriol,  or  ether  as  it  later  came  to 
be  called,was  discovered  around  1200  A.D. 
by  a Spanish  physician,  Raymondus  Lullius, 
but  it  was  not  used  in  surgery  until  1842.  In 
1540,  a method  for  making  ether  was  sold  to 
the  city  of  Nurnberg  by  Valerius  Cordus, 
Paracelcus’  apprentice  and  assistant,  for  a 
small  amount.  At  that  time  it  was  an  un- 
recognized bargain. 

Oxygen  and  Nitrous  Oxide 

In  1772,  Joseph  Priestley  discovered 
oxygen,  and  a few  years  later,  nitrous  oxide 
or  “dephlogistated  air.” 

Humphrey  Davy 

Humphrey  Davy,  who  was  subsequently 
knighted,  published  his  researches  on  N^O 
(nitrous  oxide),  and  suggested  the  possibility 
of  using  it  to  obtain  analgesis  for  minor  op- 
erations. The  suggestion  was  largely  disre- 
garded. 

Henry  Hill  Hickman 

Years  later,  around  1820,  Davy’s  book  on 
his  researches  was  read  by  a young  country 
doctor,  Henry  Hill  Hickman,  practicing  in 
Shropshire,  England.  He  discovered  that  car- 
bon dioxide  had  an  anesthetic  effect  on  an- 
imals, wrote  a paper  on  his  experiments  and 
the  possible  use  of  the  gas  for  anesthesia  in 
humans.  Hickman  went  to  Faraday  and 
Davy,  who  refused  to  read  his  paper  before 


SOUTH  DAKOTA 


the  Royal  Society  of  Physicians,  and  then  to 
France,  after  sending  a moving  request  to  the 
French  king.  Charles  X granted  him  permis- 
sion to  read  his  paper  before  French  phys- 
icians. Hickman  hopefully  departed  on  his 
journey,  only  to  find  that  the  lone  voice  of 
Baron  Larrey  Dominique,  raised  in  defense  of 
his  research,  could  not  overcome  the  preju- 
dice of  French  physicians.  Baron  Larrey 
was  Napoleon’s  physician,  and  the  first  one 
to  perform  amputations  on  freezing  battle- 
fields, where  the  cold  would  serve  as  anal- 
gestic  — a method  revived  in  our  time. 

Hickman  returned  home  to  England,  a 
broken  man  who  died  at  the  age  of  29.  His 
grave,  like  his  service  to  mankind,  was  for- 
gotten for  the  next  100  years,  until  the  Royal 
Society  of  Anesthesiologists  honored  him 
with  a plaque  in  1930. 

Morphine 

In  the  meantime,  Serturner  in  Germany 
had  isolated  morphine  from  opium,  a drug 
known  to  the  ancients  for  its  analgesic  prop- 
erties. 

Meserism 

Around  1776,  in  France,  a new  “movement” 
was  born  — Mesmerism.  The  inventor  and 
chief  proponent,  Anton  Mesmer,  used  a 
theory  which  he  called  “Vitalism”  — a com- 
bination of  hypnotism  and  hocus-pocus.  His 
method,  demonstrated  with  great  showman- 
ship, roused  the  ire  of  medical  men,  who 
roundly  condemned  him  and  his  methods. 

The  useful  content  of  Mesmer’s  method  — 
hypnotism  — was  discredited.  However, 
Mesmerism  was  far  from  dead  — it  had  its 
devotees  and  followers.  Phineas  Parker  Quin- 
ley  spread  it  to  the  United  States. 
Humanitarians  and  Closed  Minds 

The  18th  and  early  19th  Centuries  brought 
further  advances  in  anesthesia  and  analgesia, 
at  first  slowly  and  painfully;  some  of  the 
men  connected  with  the  first  attempts  at 
inhalation  anesthesia  suffered  throughout 
their  lives  and  died  in  proverty  and  illness, 
and  some  by  their  own  hand.  Their  sincere 
and  dedicated  labors  of  love  for  humanity 
were  misunderstod  and  unappreciated  by 
others,  and  the  public  they  sought  to  protect 
from  suffering  and  pain  ridiculed  and  tor- 
tured them.  The  closed  minds  of  physicians 
and  laymen  of  that  era,  inadequate  funds, 
and  lack  of  interest  all  combined  to  slow 
down  progress  in  the  advance  of  anesthesia 


and  analgesia. 

William  Crawford  Long 

A Georgia  physician,  William  Crawford 
Long,  removed  a small  vascular  tumor  from  a 
patient’s  neck  in  1842  — using  ether.  This 
was  the  beginning  of  the  era  of  “ether  fro- 
lics,” in  which  Long  himself  took  part  occas- 
ionally. Parties  were  organized,  and  the 
sniffing  of  ether  was  followed  by  exhilara- 
tion and  all  sorts  of  antics  by  the  participants. 
It  was  during  one  of  these  parties  that  a guest 
fell  and  cut  his  leg.  Afterwards  he  reported 
not  having  felt  any  pain.  Ether  now  became 
the  subject  of  more  investigation  by  Long, 
who  used  it  in  minor  surgery,  but  lack  of 
opportunity  and  apathy  among  his  neighbors 
deterred  him  from  publishing  his  results. 
Chloroform 

In  the  meantime,  chloroform  had  been  dis- 
covered, but  was  not  used  on  animals  as  an 
anesthetic  until  1847.  Dumas  in  France  an- 
alyzed its  chemical  and  physical  properties. 

Belter  Instruments 

In  1839  a system  of  puncturing  the  skin 
with  a lancet,  using  a syringe  to  deposit  a 
solution  of  morphine  directly  under  it  was 
introduced  by  Isaac  Ebenezer  Taylor  and 
James  Augustus  Washington.  The  modern 
hollow  needle  was  invented  by  Alexander 
Wood  in  Scotland,  1853,  and  Charles  Pravaz 
in  France  complemented  this  achievement  by 
adding  the  modern  syringe  to  the  healer’s 
armamentarium. 

Horace  Wells  and  Dental  Analgesia 

In  1844,  a traveling  lecturer  in  chemistry, 
Gardner  Q.  Colton,  gave  a demonstration  of 
the  effects  of  nitrous  oxide  at  Hartford,  Conn. 
Horace  Wells,  a local  dentist,  was  present  at 
the  demonstration  and  noticed  that  a young 
ship  assistant,  while  under  the  influence  of 
the  gas,  had  banged  his  shin  and  made  it 
bleed,  but  stated  that  he  had  felt  no  pain. 
Wells  was  greatly  impressed  and  asked  Col- 
ton to  give  the  gas  to  a patient  during  a tooth 
extraction  — until  then  a very  painful  and 
harrowing  procedure,  tough  on  patient  and 
dentist.  On  the  following  day.  Wells  himself 
was  the  patient  in  a painless  tooth  extraction, 
with  Colton  acting  as  anesthetist,  Riggs  as 
dentist. 

Later  in  the  year  Wells  went  to  Boston  to 
demonstrate  the  gas  before  a larger  audience. 
Unfortunately,  something  went  wrong,  the 
patient  on  the  stage  felt  pain,  and  Wells  was 


— 92  — 


MARCH  1958 


hissed  out  of  the  auditorium.  He  returned  to 
Hartford  and  continued  to  use  the  gas,  but 
ether  gradually  ousted  the  use  of  nitrous 
oxide.  Wells,  bitterly  disappointed,  gave  up 
dentistry,  became  a bird  fancier  among  other 
things,  and  traveled  around  the  country  with 
performing  canaries.  He  was  jailed  for  spat- 
tering a New  York  prostitute  with  acid,  and 
committed  suicide. 

Morton  and  Ether 

William  Thomas  Green  Morton  probably 
deserves  the  chief  credit  for  introducing  ether 
as  an  anesthetic  agent  in  the  United  States, 
although  W.  E.  Clark  of  Rochester,  N.  Y., 
gave  ether  for  a dental  extraction  in  1842,  and 
William  Crawford  Long  removed  a tumor 
from  a patient’s  neck  a few  months  after 
Clark’s  experiment.  By  the  time  (1849)  that 
Long  reported  on  his  work,  Morton’s  fame 
was  well  established. 

Morton  was  a dentist  who  became  a stu- 
dent and  later  a partner  of  Wells  in  Hart- 
ford. He  separated  from  Wells  and  became  a 
medical  student  in  Boston.  He  was  present 
at  the  ill-fated  demonstration  of  the  effective- 
ness of  nitrous  oxide  by  Wells. 

Charles  A.  Jackson,  one  of  Morton’s  lec- 
turers at  Harvard,  suggested  that  ether 
might  be  used  as  a local  anesthetic  in  dentis- 
try. Morton  went  further:  he  experimented 
on  dogs  to  find  out  the  effects  of  giving  ether 
vapor  by  inhalation.  Impressed  with  the  re- 
sults, he  gave  ether  to  Eben  Frost  for  a tooth 
extraction  in  1846.  It  proved  painless.  After 
gaining  further  experience,  Morton  gave  a 
demonstration  at  the  Massachusetts  General 
Hospital  while  he  was  still  a student  — Oc- 
tober 16,  1946  — when  Dr.  Warren,  the  sur- 
geon, removed  a tumor  from  a patient’s  jaw 
without  producing  any  pain. 

A great  controversy  developed  between 
Morton  and  Jackson  as  to  who  should  receive 
credit  for  the  discovery  of  ether  for  surgical 
anesthesia,  lasting  through  both  their  life- 
times and  causing  great  bitterness.  Morton 
unsuccessfully  petitioned  the  U.  S.  Congress 
three  times  to  gain  this  recognition,  which 
was  denied  him  until  after  his  death.  He  died 
of  a cerebral  hemorrhage,  reportedly  after 
reading  one  of  Jackson’s  vitriolic  attacks 
against  him.  Jackson,  seeing  a statue  in  a 
Boston  Park  erected  to  honor  Morton,  went 
out  of  his  mind  and  attacked  the  statue.  He 
ended  his  life  in  a mental  institution.  Mor- 


ton’s agent,  which  he  had  tried  to  patent 
under  the  name  Letheon,  became  widely 
used. 

John  Snow 

England’s  leading  anesthetist  at  this  period 
was  John  Snow,  whose  epitaph  described  him 
as  the  man  who  “.  . . made  the  art  of  anes- 
thesia a science.”  Snow  wrote  an  influential 
book  in  1847,  On  The  Inhalation  of  Ether,  but 
he  later  abandoned  ether  for  chloroform.  He 
knew,  however,  the  dangers  of  chloroform, 
believing  that  too  strong  a dose  of  it  caused 
primary  cardiac  failure.  To  overcome  this 
danger,  he  invented  a percentage  chloroform 
inhaler.  He  gave  more  than  4,000  chloroform 
anesthetics  without  a death.  In  1853,  Snow 
originated  the  method  of  “chloroform  a la 
reine,”  when  he  acted  as  anesthetist  at  the 
birth  of  Queen  Victoria’s  eighth  child.  Prince 
Leopold.  He  gave  his  royal  patient  small 
doses  intermittently  on  a handkerchief,  the 
total  administration  lasting  53  minutes. 

The  Turning  Point 

The  halfway  mark  of  the  19th  Century  was 
the  approximate  turning  point  in  the  history 
of  anesthesiology.  After  the  heartbreak, 
frustration  and  individual  tragedies  of  the 
early  pioneers,  the  clouds  of  public  and  pro- 
fessional hostility  and  prejudice  parted. 
There  succeeded  a period  of  activity  and  dis- 
covery which  is  still  in  progress. 

A new  era  in  anesthesia  was  open  with  the 
introduction  in  1934  of  thiopental  sodium,  an 
intravenous  anesthetic.  This  and  subsequent 
similar  agents  exhibited  advantages  over 
agents  previously  used.  These  products  and 
their  advantages  are  discussed  in  the  next 
section. 

II.  METHODS  OF  PRODUCING 
ANESTHESIA 

The  terms  “anesthesia”  and  “analgesia”  are 
not  interchangeable.  Anesthesia  means  the 
production  of  complete  unconsciousness,  mus- 
cular relaxation  and  absence  of  pain  sensa- 
tion for  the  performance  of  surgery.  Anal- 
gesia means  the  reduction  or  elimination  of 
pain  sensibility  while  the  patient  remains 
conscious. 

The  choice  of  the  method  to  be  used  to  pro- 
duce either  condition  rests  with  the  anes- 
thetist, who  makes  the  decision  on  the  basis 
of  the  patient’s  age  and  general  condition,  the 
type  of  operation,  the  length  of  time  the  op- 
eration will  take,  the  temperament  of  the  pa- 


4 


— 93  — 


SOUTH  DAKOTA 


tient,  and  the  position  the  patient  will  have 
to  be  put  in  on  the  operating  table.  In  ad- 
dition, a patient  may  be  allergic  to  a par- 
ticular anesthetic  agent. 

Inhalation  Anesthesia: 

The  patient  is  put  into  an  unconscious 
state  by  breathing  the  vapor  of  an  anesthetic. 
This  is  accomplished  either  by  a gauze-cov- 
ered mask,  on  which  drops  of  the  anesthetic 
are  allowed  to  fall  at  a controlled  rate,  or  by 
a closed  or  semi-closed  system,  by  which  the 
patient  is  connnected  to  complicated  gas- 
measuring and  administering  machinery,  and 
keeps  rebreathing  the  anesthetic  gas  mixture 
to  maintain  the  proper  level  of  anesthesia. 

The  mask  method,  usually  in  combination 
with  ether  as  the  anesthetic,  can  be  used  even 
in  emergency  conditions,  when  hospitals  and 
skilled  anesthetists  are  not  available.  In 
major  operations  and  other  more  difficult 
cases,  the  responsibilities  of  the  anesthetist 
become  greater.  While  his  chief  function  is  to 
prevent  and  alleviate  pain,  his  primajy  re- 
sponsibility is  to  maintain  respiration  and 
keep  the  patient  alive. 

Surgeons  frequently  insist  on  working  with 
the  same  anesthetist  on  all  their  cases;  their 
teamwork  is  so  coordinated  that  a look  or 
slight  gesture  suffices  to  apprise  either  one 
of  changes  in  the  patient’s  condition,  which 
may  require  immediate  action  on  the  part  of 
either  or  both.  The  anesthetist  must  be  con- 
stantly alert  to  a number  of  things:  The  anes- 
thesia machinery  directly  concerned  with  the 
anesthetic  administration;  pressure  and  rate 
of  gas  and  gas  mixture  proportion;  the  breath- 
ing bag  which  helps  to  indicate  the  patient’s 
breathing  rate  and  depth;  the  patient’s  pulse, 
blood  pressure,  temperature,  heart  and  brain 
action.  Whole  blood,  plasma,  electrolytes 
(saline  solutions,  etc.),  emergency  drugs  must 
be  instantly  available. 

The  depth  of  the  anesthesia  must  be  con- 
trolled. Many  agents  have  a small  margin  of 
safety;  anesthesia  must  not  be  too  light,  so 
that  the  patient  is  not  completely  “under,” 
while  too  much  of  it  may  seriously  depress 
the  patient’s  breathing.  The  anesthetist  must 
guard  the  patient  from  choking  on  body 
fluids  and  stomach  contents  aspirated  during 
surgery.  All  anesthetic  agents  for  inhalation 
are  used  in  combination  with  oxygen.  The 
normal  ratio  of  21  percent  oxygen  in  the  air 
we  breathe  must  be  maintained  during  anes- 


thesia. 

The  commonest  agents  used  are: 

1)  Nitrous  oxide  (“laughing  gas”);  sweet- 
smelling, non-irritating,  colorless  gas. 

2)  Cyclopropane:  colorless  gas  with  sweet 
smell.  It  is  useful  in  cases  requiring  smooth 
breathing,  with  minimal  after  affects  and 
minimal  respiratory  irritation. 

3)  Ether:  colorless  volatile  liquid  which 
turns  to  gas  when  exposed  to  air  or  oxygen. 
Advantages:  It  is  relatively  non-toxic,  and 
produces  excellent  relaxation  without  undue 
respiratory  depression.  Respiratory  depres- 
sion is  not  accompanied  by  serious  cardiac 
damage,  and  artificial  respiration  will  usually 
overcome  effects  of  temporary  overdosage. 
Disadvantages:  It  tends  to  irritate  the  breath- 
ing apparatus,  to  upset  the  body  chemistry, 
to  irritate  the  kidneys,  and  to  explode  when 
in  contact  with  sparks,  flames,  and  hot  sur- 
faces. 

4)  Chloroform:  clear,  sweet-smelling,  heavy 
liquid.  It  is  non-inflammable  but  in  its  liquid 
form  is  irritating  to  the  skin  and  mucous 
membranes. 

5)  Ethyl  chloride:  a clear  fluid  with  an 
ether-like  odor. 

6)  Divinyl  ether  (or  divinyl  oxide):  a clear 
fluid  with  non-irritating  odor. 

Intravenous  Anesthesia 

In  recent  years,  the  intravenous  route  of 
administration  has  become  more  popular. 
Thiopental  sodium,  introduced  in  1934,  was 
the  first  anesthetic  of  this  type  to  gain  wide 
acceptance.  Others  with  wide  acceptance  are 
thiamylal  sodium  and  hexobartital  sodium. 

In  1956  Sobering  Corporation  introduced 
methitural  sodium,  under  the  trade  name 
Neraval.  This  agent  has  advantages  over 
other  ultra  short-acting  thiobarbiturates. 

A barbiturate  is  a derivitive  of  barbituric 
acid,  used  in  medicine  as  a hypnotic  or  seda- 
tive drug,  or  in  larger  doses  as  an  analgesic 
or  anesthetic.  A thiobarbiturate  is  a derivitive 
of  thiobarituric  acid,  differing  slightly  from 
barbiturates,  but  similar  in  effect. 

These  intravenous  agents  produce  a degree 
of  basal  narcosis  which  may  be  adequate  for 
short  surgical  procedures,  but  none  of  them 
are  both  analgesic  and  anesthetic.  They  have 
certain  advantages  over  inhalation  agents: 
rapid,  peasant  induction;  simplicity  of  admin- 
istration; lack  of  pulmonary  irritation;  less 


— 94  — 


MARCH  1958 


nausea  and  vomiting  during  recovery;  no  ex- 
plosion hazard. 

Route  of  administration  is  through  a needle 
into  a vein  of  the  arm  or  foot.  Sleep  is  very 
rapid,  usually  in  seconds,  and  is  not  unpleas- 
ant for  the  patient.  Frequently,  one  of  the 
gases  and  oxygen  are  used  after  the  intra- 
vanous  agent  has  taken  effect.  Such  a com- 
bination of  methods  and  agents  is  called  bal- 
anced anesthesia,  a term  which  represents 
“anesthesiology  at  its  best  and  is  employed 
more  and  more  in  better  clinics  throughout 
the  country.”  (Understanding  Surgery,  Dr. 
Robert  E.  Rothberg,  Fellow  of  the  American 
College  of  Surgeons,  New  York,  1955.) 

Amost  every  operation  in  surgery  has  been 
performed  under  intravenous  anesthesia,  but 
it  is  held  especially  useful; 

1)  For  induction  of  general  anesthesia; 

2)  For  short  operations: 

3)  Under  service  conditions  where  port- 
ability and  relative  ease  of  administra- 
tion are  advantages; 

4)  For  supplementing  regional  anesthesia; 

5)  In  the  presence  of  a cautery; 

6)  For  controlling  convulsions  during  gen- 
eral or  local  anesthesia; 

7)  For  narco-analysis  in  psychiatry,  and 
for  electroconvulsive  therapy. 

Neraval  has  demonstrated  a number  of  ad- 
vantages over  other  intravenous  anesthetics: 

1)  Less  of  it  is  retained  in  the  body,  there- 
fore there  is  much  faster  detoxification. 

2)  There  is  less,  and  usually  no,  unpleasant 
after  effects. 

3)  Total  recovery  is  faster  and  more  com- 
plete. 

4)  There  is  a greater  margin  of  safety. 

Because  of  rapid  degradation,  less  Neraval 

is  retained  in  the  body  than  other  thiobarbitu- 
rates.  The  anesthesiologist,  therefore,  is  bet- 
ter able  to  control  the  desired  depth  of  anes- 
thesia, and  with  greater  safety.  The  absence 
of  after  effects,  such  as  nausea,  vomiting, 
dizziness,  has  a decided  advantage  in  hospital 
administration,  for  the  patient  is  often  able  to 
go  directly  to  his  bed,  by-passing  the  recovery 
room. 

In  the  doctor’s  office,  dentist’s  office  or  in 
out-patient  clinic,  the  patient  can  be  anesthe- 
sized  and  fully  recovered  in  15  to  30  minutes 
and  able  to  go  home  unassisted.  This  rapid 
recovery  is  in  contrast  with  almost  an  hour  or 
more  for  thiopental  sodium. 


The  intravenous  agents  described  here  are 
the  most  important,  but  there  are  others 
which  are  used  occasionally  or  under  special 
circumstances. 

Spinal  Anesthesia 

This  method  is  perhaps  the  commonest  type 
used  for  operations  within  the  abdominal  cav- 
ity. By  placing  a long,  thin  needle  into  the 
spinal  canal,  an  anesthetic  agent,  such  as  no- 
vocaine,  is  injected  in  calculated  doses  into 
the  spinal  fluid.  By  manipulating  the  dosage, 
the  site  of  injection  and  position  of  the  pa- 
tient on  the  operating  table,  the  desired  level 
of  anesthesia  is  obtained. 

Spinal  anesthesia  completely  anesthetizes 
that  portion  of  the  body  supplied  by  the  anes- 
thetic injected  into  the  spinal  canal.  Thus,  the 
abdomen  and  lower  extremities  can  be  ren- 
dered insensitive  to  pain  while  the  patient 
remains  conscious  and  alert. 

The  fears  of  complication  from  spinal  anes- 
thesia date  back  20  or  30  years  when  non- 
medical anesthetists  officiated.  Today,  spinal 
anesthesia  is  one  of  the  safest  of  all  forms 
when  given  by  a properly  qualified  anes- 
thetist. A troublesome  complication,  which 
is  never  permanent  yet  frequently  annoying, 
is  postspinal  headache.  This  symptom  occurs 
in  about  5 percent  of  all  cases  and  lasts  any- 
where from  two  days  to  two  weeks  after  sur- 
gery. 

Drugs  Used  to  Produce  Spinal  Anesthesia: 

1)  Cocaine:  this  was  the  first  drug  used, 
but  has  now  been  entirely  given  up. 

2)  Stovaine:  was  popular  for  many  years, 
but  is  now  known  to  be  irritating  and  has 
lost  much  of  its  popularity. 

The  following  four  are  the  chief  drugs  used 
today  in  spinal  anesthesia: 

3)  Novocaine:  analgesia  lasts  from  40  to  80 
minutes. 

4)  Amethocaine  Hydrochloride:  of  slower 
onset  than  novocaine,  but  longer  lasting, 
i.e.,  from  IVa  to  IVz  hours. 

5)  Nupercaine:  also  has  a slower  onset  but 
longer  duration,  from  V-k  to  3 hours. 

6)  Metycaine:  a little  stronger,  and  lasts 
longer,  than  novocaine. 

Epidural  and  Caudal  Anesthesia 

These  methods  are  similar  to  spinal  in  that 
they  deaden  for  a few  hours  the  spinal  nerves, 
thus  anesthetizing  various  regions  of  the 
body.  They  differ  from  spinal  anesthesia  in 
that  the  anesthetic  agent  is  placed  outside 


— 95  — 


SOUTH  DAKOTA 


the  spinal  canal  rather  than  within  the  canal. 
Although  the  completeness  of  the  anesthesia 
may  not  be  quite  as  great  as  in  spinal  anes- 
thesia, epidural  blocks  have  the  advantage  of 
protecting  patients  against  postspinal  head- 
aches. Caudal  anesthesia  has  attained  con- 
siderable vogue  here  lately  in  obstetrics, 
where  it  does  much  to  eliminate  labor  pains. 
Regional  Anesthesia 

This  represents  “one  of  the  highest  develop- 
ments of  the  anesthesiologists  art.”  (Rothen- 
berg:  Understanding  Surgery).  By  means  of 
needles  placed  in  various  regions  of  the  body, 
anesthetic  solutions  (e.g.,  novocaine)  are  in- 
jected to  “block”  or  “deaden”  temporarily 
specific  nerves  supplying  particular  parts  of 
the  body.  Thus,  only  the  arm,  hand,  tongue, 
neck  or  side  of  the  face  may  be  anesthetized 
if  the  operation  is  to  be  limited  to  these  areas. 
The  advantage  of  this  technique  is  that  the 
heart,  lungs,  blood  pressure  and  general  con- 
dition of  the  patient  are  unaffected  by  the 
blocking  of  specific  nerves  and  many  poor- 
hisk  patients  who  could  not  ordinarily  with- 
stand a general  or  spinal  anesthesia  can  be 
rendered  operable. 

Topical  Anesthesia 

This  form  of  anesthesia  consists  of  spraying 
or  painting  an  agent  such  as  cocaine  or 
cyclaine  onto  a mucous  membrane  surface. 
It  is  limited  almost  entirely  to  eye,  nose  and 
throat  procedure.  In  some  instances,  it  is  used 
merely  to  induce  superficial  anesthesia  and 
is  followed  by  injections  of  novocaine  or 
similar  local  anesthetics.  It  is  also  commonly 
used  to  aid  the  passage  of  tubes  into  the 
trachea  (windpipe)  or  esophagus  (food  pas- 
sage.) 

In  addition  to  the  anesthetic  agents,  there 
are  muscle  relaxant  drugs.  These  drugs,  such 
as  curare  (an  old  Indian  poison  used  on 
arrowheads)  or  succinyl-choline,  when  given 
by  injection  in  proper  amounts,  produce  great 
relaxation  of  the  muscles  of  the  body.  Good 
muscle  relaxation  lessens  the  amount  of  anes- 
thetic agent  which  must  be  given,  and  aids 
the  surgeon  markedly  in  performing  his  op- 
erative work. 

A SHORT  BIBLIOGRAPHY  OF  ANESTHESIA 
ADAMS,  R.  Charles:  Intravenous  Anesthesia. 
New  York,  London,  P.  B.  Hoeber  (Medical 
Book  Department  of  Harper  & Bros.),  1944. 
AMERICAN  MEDICAL  ASSOCIATION,  Council 
on  Pharmacy  and  Chemistry;  Fundamentals 

CLEMENT,  F.  W.;  Niirous-Oxide  Oxygen  Anes- 
thesia. 3 ed.  Philadelphia,  Lea  & Febiger,  1951. 


FLAGG,  P.  J.:  The  Art  of  Anesthesia.  7 ed.  Phila- 
delphia, J.  B.  Lippincott,  1944. 
FULOP-MILLER,  Rene:  Triumph  Over  Pain. 
Translated  by  Eden  and  Cedar  Paul.  New 
York,  The  Literary  Guild  of  America,  Inc., 
1938. 

GILLESPIE,  Noel  A.:  Endotracheal  Anesthesia.  2 
ed.  Madison,  University  of  Wisconsin,  1948. 
GUEDEL,  Arthur  E.;  Inhalation  Anesthesia,  a 
fundamental  guide.  2 ed.  New  York,  The  Mac- 
millan Company,  1951. 

HERTZLER,  A.  E.:  The  Technic  of  Local  Anes- 
thesia. 6 ed.  St.  Louis,  C.  V.  Mosby,  1937. 

LEE,  J.  Alfred:  A Synopsis  of  Anesthesia.  3 ed. 

Baltimore,  Williams  and  Wilkins  Co.,  1953. 
LUNDY,  J.  S.:  Clinical  Anesthesia.  Philadelphia  & 
London,  W.  B.  Saunders,  1942. 

MAXSON,  Louis  H.:  Spinal  Anesthesia.  Philadel- 
phia, J.  B.  Lippincott,  1938. 

NOSWORTHY,  Michael  D.:  The  Theory  and  Prac- 
tice of  Anesthesia.  London,  Hutchinson  Scien- 
tific, 1935. 

ROBBINS,  Benjamin  H.:  Cyclopropane  Anesthesia. 
Baltimore,  Williams  and  Wilkins  Co.,  1940. 

III.  ANESTHESIA  GLOSSARY 

ANALGESIA  — Absence  of  sensibility  to  pain. 

(pain) 

ANESTHESIA  — Loss  of  feeling  or  sensation, 
(sensation) 

especially  loss  of  tactile  sensibility,  though  the 
term  is  used  for  loss  of  any  of  the  other  senses. 
ANESTHESIOLOGIST  — A physician  who  special- 
izes in  the  practice  of  anesthesiology. 
ANESTHETIC  — A drug  which  produces  local  or 
general  loss  of  sensibility. 

ANESTHETIST  — An  expert  in  administering 
anesthetics.  This  term  usually  is  applied  to 
nurses. 

DESATURATION  — The  act  or  process  of  reliev- 
ing the  saturated  state. 

DRIP  METHOD  — Continuous  intravenous  instil- 
(intravenous) 

lation,  drop  by  drop,  of  saline  or  other  solu- 
tion. 

ENDOTRACHEAL  — Endo  (within)  — Tracheal 
(pertaining  to  the  trachea). 

EPIDURAL  — Situated  upon  or  outside  the  ura 
(the  fibrous  membrane  forming  the  outermost 
covering  of  the  brain  and  spinal  cord). 
HYYOXIA  — Low  oxygen  content  or  tension; 

deficiency  of  oxygen  in  the  inspired  air. 
HNHALATION  ANESTHESIA  — Gaseous  anes- 
thesia applied  by  respiration. 
INTRATRACHAEL  INSUFFLATION  — The  op- 
eration of  blowing  air  into  the  trachea  through 
a tube  introduced  into  the  larnyx;  employed  to 
avoid  collapse  of  the  lungs  in  intrathoracic 
operations. 

INTUBATION  — The  insertion  of  a tube;  espe- 
cially the  introduction  of  a tube  into  the 
larynx  through  the  glottis,  performed  in  diph- 
theria and  edema  of  the  glottis  for  the  intro- 
duction of  air. 

SALINE  — Salty;  of  the  nature  of  salt;  contain- 
ing a salt  or  salts. 

SATURATION  — The  act  of  saturating  or  con- 
dition of  being  saturated. 

IV.  THE  ANESTHESIOLOGIST  AS  A 
MEMBER  OF  THE  OPERATING  TEAM 

Since  most  of  the  anesthesiologist’s  work  is 
caried  out  while  the  patient  is  unconscious, 
people  obviously  know  little  about  it. 

Let  us  suppose  you  enter  the  hospital  for 
an  elective  operation.  What  can  you  expect 

(Continued  on  Page  107) 


— 96  — 


The  week  of  April  20-26th  has  been  set  aside  as  Medical  Education  Week.  As  members 
of  the  medical  profession  we  should  make  a concerted  effort  to  inform  the  public  of  the  role 
of  medical  schools  in  training  physicians,  in  research  and  service  to  the  nation.  We  must  em- 
phasize the  need  for  more  medical  schools  and  more  money  for  those  already  established. 

Since  1952  there  has  been  a remarkable  decrease  in  qualified  applicants  to  medical  schools. 
Increased  interest  in  other  sciences,  business,  advertising  and  notably  engineering  has  oc- 
curred. These  fields  siphon  off  many  students  who  might  qualify  for  medical  school.  Four 
to  ten  years  beyond  the  normal  four  years  of  college  with  low  earning  power  and  heavy  ex- 
penses discourage  many.  Immediate  solutions  to  the  many  problems  are  not  evident.  It  is 
unthinkable  to  lower  the  standards  of  our  schools.  Perhaps  some  method  of  subsidizing  med- 
ical students  should  be  devised.  Every  effort  should  be  made  to  support  medical  schools  and 
students  from  private  sources. 

In  South  Dakota  we  have  two  separate  and  distinct  ways  of  subsidizing  medical  education. 
First:  contributions  to  the  American  Medical  Education  Foundation  are  transmitted  in  full  to 
medical  schools  to  keep  them  out  of  financial  difficulties.  Second:  gifts  to  the  South  Dakota 
Medical  School  Endowment  Fund  builds  up  the  revolving  fund  that  is  now  lending  money  to 
deserving  South  Dakota  medical  students.  Neither  of  these  funds  use  any  contributed  money 
for  administrative  expenses.  With  more  money  in  the  revolving  fund  more  students  can  be 
helped. 

M.  M.  Morrissey,  M.D. 

Pierre,  South  Dakota 


a 


— 97  — 


MEDICAL  EDUCATION  WEEK 

Medical  Education  Week  is  sponsored  by 
the  American  Medical  Association  and  other 
organizations  to  awaken  the  public  to  the 
need  for  voluntary  funds  for  medical  educa- 
tion. The  objectives  are  to  focus  attention  on, 
and’ to  inform  the  public  of,  the  ever  increas- 
ing contribution  of  medicine  to  American  life, 
and  to  the  basic  significance  of  medical  edu- 
cation. 

The  program  is  an  attempt  to  develop  pub- 
lic understanding  of  the  progress,  aims,  and 
problems  of  medical  education  with  the  hope 
of  stimulating  its  more  adequate  financial 
support  by  the  public.  Efforts  are  directed 
towards  informing  the  pubic  of  the  compre- 
hensive role  the  medical  schools  have  in  edu- 
cation, research,  and  service. 

Dates  set  for  the  observance  of  Medical 
Education  Week  this  year  are  April  20th 
through  26th.  Each  medical  school  dean,  each 
student  AMA  president,  and  each  AMEF 
chairman  has  been  invited  to  join  in  promot- 
ing the  campaign. 

Kick-off  Medical  Education  Week  was 
made  by  President  Eisenhower  in  a telegram 
sent  to  Dr.  David  B.  Allman,  President  of 
the  American  Medical  Association,  in  which 
he  said  “In  this  great  era  of  American  med- 
icine, it  is  fitting  that  we  set  aside  a special 
week  each  year  to  consider  the  work  of  our 
medical  schools. 

Progress  has  been  made  in  the  expansion  of 
medical  school  enrollments,  in  research  and 
community  services,  but  during  the  current 
year  I hope  we  can  take  additional  steps  to 


strengthen  medical  education.  To  this  end,  I 
have  again  asked  Congress  to  enact  pending 
legislation  to  provide  federal  assistance  for 
the  construction  of  medical  teaching  facilities. 

Our  people  are  well  aware  of  the  role  of 
modern  medicine  in  this  national  health 
structure,  and  I know  they  will  support,  by 
private  and  public  means,  the  continued 
growth  of  medical  education  in  this  country.” 


DOCTORS  AND  POLITICS 

Happened  recently  to  run  into  a member 
of  congress  who  is  also  a doctor  of  medicine. 
In  the  group  talking  to  the  Congressman 
was  a South  Dakota  banker  and  a U.  S.  Sen- 
ator. 

The  conversation  turned  to  doctors,  their 
participation  in  political  battles,  etc.  when 
the  banker  asked  for  quiet  so  he  could  pose 
a question. 

“Why  is  it,”  he  said,  “that  the  doctors  are 
most  vocal  on  legislation  but  refuse  to  give 
money  to  their  political  parties  in  an  attempt 
to  get  men  elected  who  understand  their 
views?” 

I let  the  doctor-congressman  answer  the 
question  — but  it  gave  me  pause.  Is  it  be- 
cause our  doctors  are  politically  naive,  or 
perhaps  just  not  politically  conscious?  At  any 
rate,  its  worth  thinking  about.  If  you  wish 
to  have  the  kind  of  lawmakers  who  believe 
as  you  believe,  it  is  necessary  for  you,  as  lead- 
ing citizens,  to  support  those  candidates 
through  their  political  parties. 

J.  C.  F. 


98  — 


MARCH  1958 


THE  MONTH  IN  WASHINGTON 

Those  who  are  trying  to  follow  the  course 
of  medical  legislation,  find  an  unusual  situa- 
tion developing  in  this  session  of  Congress. 
All  of  Washington  is  being  subjected  to  for- 
ces, some  completely  new,  that  often  work  at 
cross-purposes  to  each  other.  The  result  could 
be  a moratorium  on  health  legislation  — or 
again  it  could  be  a flood  of  new  laws. 

At  the  start  of  the  session,  a new-born  in- 
terest in  science  completely  dominated  the 
scene  — by  a frantic  spending  of  billions  of 
dollars  we  would  overtake  Russia.  That  was 
the  theme  in  Washington,  and  it  persisted 
despite  a few  quiet  voices  that  asked  whether 
Russia  really  had  far  outdistanced  the  U.  S. 
or  was  merely  exploiting  a slight  advantage. 

Even  before  the  American  satellite  started 
on  its  orbit,  some  of  the  panic  had  subsided, 
and  most  of  the  legislators  had  decided  that 
advent  of  the  space  age  had  not  removed  all 
of  the  old  problems  and  opportunities  in 
legislation  and  politics.  The  familiar  issues 
were  still  there,  medical  panaceas  included. 

The  shock  of  Russian  achievements  will, 
at  any  rate,  produce  legislation  designed  to 
shore  up  our  educational  system.  This  seems 
to  be  generally  accepted.  For  the  medical 
profession,  two  provisions  are  of  major  in- 
terest. Scholarships  would  be  either  four 
years  — possibly  six  — offering  some  assist- 
ance to  premed  students  and  in  some  cases  to 
those  in  their  first  year  of  medical  school. 
Also,  fellowships  would  be  available  for  med- 
ical and  other  graduates  if  they  wanted  to 
teach  or  go  into  research. 

The  administrations  idea  was  a program 
that  would  cost  a billion  dollars;  several  lead- 
ing Democrats  joined  in  a bill  proposing  three 
billion  dollars  as  a stimulant  to  mathematics 
and  science. 

But  there  are  other  factors  to  be  reckoned 
with.  For  the  first  time  a President  set  down 
in  black  and  white  in  his  budget  just  how  he 
proposed  to  withdraw  the  federal  government 
from  some  activities,  or  limit  its  participation, 
and  turn  the  programs  back  to  the  states.  Mr. 
Eisenhower  wants  to  slow  down  on  the  Hill- 
Burton  hospital  construction  program  and 
change  its  emphasis,  he  wants  to  mesh  in 
some  veterans’  benefits  with  social  security 
payments,  he  would  have  the  states  do  more 
and  the  U.  S.  less  in  public  assistance  (where 
medical  payments  are  a growing  factor),  and 


he  hopes  to  get  Congress  to  drop  the  $50  mil- 
lion a year  program  of  grants  to  help  build 
water  treatment  plants. 

Whether  Congress  will  follow  the  Presi- 
dent’s lead  in  the  back-to-the-states  move- 
ment is  another  question.  At  least  he  has  said 
specifically  what  he  thinks  should  be  done, 
and  when. 

There  was  no  expectation  that  the  Russian 
scare  would  dilute  politics  this  election  year 
— and  it  hasn’t.  If  anything,  the  partisans 
are  struggling  harder  than  ever  to  make  rec- 
ords that  will  reflect  glory  on  them  next 
November.  Some  of  course,  would  be  press- 
ing for  their  projects  regardless  of  the  elec- 
tion. 

So  this  is  the  prospect,  in  brief: 

The  Defense  Department  and  science  will 
get  the  major  attention  and  the  major  money, 
but  some  may  spill  over  into  medicine. 

There  is  some  interest  in  a tight  domestic 
budget  and  returning  certain  activities  to  the 
states,  but  old  fashioned  politics  combined 
with  a fear  of  a continuing  recession  may 
again  open  up  the  federal  purse. 

Medical  legislation,  always  a popular  sub- 
ject, may  get  more  and  more  attention  as  the 
session  rolls  on.  If  so,  the  Forand  bill  among 
others  would  come  immediately  to  the  fore. 
NOTES: 

Several  developments  in  the  legislative 
field  on  Jenkins-Keogh  bills  came  early  in 
the  session.  The  American  Thrift  Assembly, 
representing  some  10  million  self-employed, 
urged  favorable  House  Ways  and  Means  ac- 
tion, and  the  American  Medical  Association 
pointed  out  that  the  proposal  for  tax  defer- 
ment of  money  paid  into  retirement  plans 
could  help  solve  the  problem  of  maldistribu- 
tion of  physicians. 

In  the  Senate,  a majority  of  the  Small  Bus- 
iness Committee  introduced  a tax  relief  bill 
with  a J-K  provision.  The  section  would 
allow  anyone  not  now  benefitting  from  a 
qaulified  pension  plan  to  set  aside  10%  of  an- 
nual income  ($1,000,  maximum).  The  bill  went 
to  Senate  Finance  Committee. 

* * * 

A limited  number  of  medical  scientists 
from  this  country  and  Russia  will  give  lec- 
tures in  each  other’s  countries  this  year  in  an 
exchange  program  worked  out  by  the  State 

(Continued  on  Page  103) 
in  Advertising  Section 


i 


— 99  — 


ECONOMICS 


DOCTORS.  HEART  ASSOCIATIONS.  AND 
UNITED  FUNDS 

A Message  to  Physicians  from,  the  President 
of  the  American  Heart  Association 
Robert  W.  Wilkins.  M.D. 


As  the  American  Heart  Association  ap- 
proaches its  second  decade  as  a national  vol- 
untary health  agency,  we  find  its  promise  of 
continued  success  being  threatened  by  a 
movement  that  is  serious  in  nature  and  large 
in  scope. 

Just  when  we  begin  to  glimpse  where  and 
how  the  answers  to  strokes,  coronary  disease 
and  hypertension  may  be  found,  we  are 
turned  aside  from  our  main  task  by  the  neces- 
sity of  defending  ourselves  against  an  organ- 
ized effort  designed  to  regiment  us  into  a 
single  plan  of  fund  raising.  Knowing  that 
doctors,  of  all  people,  demand  for  themselves 
and  champion  for  others  the  right  of  fair  and 
equal  opportunity  and  the  privilege  of  in- 
dividual enterprise,  I am  addressing  myself 
to  you,  the  members  of  my  own  profession, 
in  the  hope  that  you  will  help  us  to  maintain 
the  Heart  Association  as  a free  American  in- 
stitution. 

I am  referring,  of  course,  to  the  effort  now 
being  made  by  United  Funds  to  force  the  na- 
tional voluntary  health  agencies  into  giving 
up  their  independent  campaigns.  However, 
at  the  outset  I wish  to  make  one  point  chystal 
clear;  we  in  the  heart  associations  are  not 
fighting  United  Funds;  we  are  striving  to  con- 
tinue and  expand  a scientific  program  de- 
signed to  conquer  the  cardiovascular  diseases 
through  the  combined  voluntary  efforts  of 
the  medical  profession  and  the  public.  We 


regard  federated  plans  of  fund  raising,  es- 
pecially for  local  charity  causes,  as  fully 
worthy  of  support,  provided  they  are  truly 
voluntary  and  not  forced  on  either  the  people 
or  the  participating  agencies.  We  certainly 
want  all  community  chests  to  succeed,  and 
will  do  everything  in  our  power,  short  of 
participating  actively  in  their  campaigns,  to 
help  them  accomplish  their  goals. 

Now  what  has  this  matter  of  fund  raising  got 
to  do  with  the  medical  profession?  As  the 
world  becomes  more  complex  and  more  an- 
xiety ridden,  people  everywhere,  including 
those  here  in  the  United  States,  are  being 
asked  to  turn  to  government  for  “womb  to 
tomb”  security,  including  socialized  medical 
care. 

A major  influence  restraining  this  drift 
toward  governmental  domination  has  been 
the  development  of  a unique  and  typically 
American  institution,  the  national  voluntary 
health  agency.  This  is  usually  an  association 
or  society  devoted  to  a limited  or  specific  pur- 
pose, such  as  the  prevention  and  control  of  a 
single  disease.  It  often  comes  into  being  in 
response  to  a profound  conviction  on  the  part 
of  individuals — laymen  and  physicians — that 
their  combined  efforts  are  needed  to  combat 
a major  health  menace.  These  citizens  decide 
on  their  own  to  do  something — not  to  rely 
solely  on  government.  What  could  be  more 
American  than  this? 


— 100  — 


MARCH  1958 


The  contributions  to  medicine  made  by 
the  national  voluntary  health  agencies  dur- 
ing the  past  decade  have  been  impressive. 
Polio  appears  to  be  on  its  way  out.  Cancer’s 
early-detection  campaign  is  saving  an  esti- 
mated 75,000  lives  a year.  In  a half  century, 
the  National  Tuberculosis  Association  has 
spearheaded  a 90  per  cent  reduction  in  that 
disease.  In  just  10  years,  the  Heart  Fund  has 
channeled  over  25  million  dollars  into  re- 
search which  has  produced  vital  new  methods 
of  diagnosis,  prevention  and  treatment  of 
cardiovascular  diseases. 

Now  here  is  a very  important  point;  by  es- 
tablishing such  national  voluntary  health 
agencies,  the  American  people  have  not  only 
promoted  health,  they  have  also  protected 
themselves,  and  especially  the  medical  pro- 
fession, from  increasing  governmental  dom- 
ination of  the  health  field.  The  Heart  Asso- 
ciation, the  Cancer  Society,  the  Polio  Founda- 
tion, and  others,  have  acted  as  buffers  be- 
tween private  medicine  and  governmental 
medicine. 

I do  not  mean  to  deny  to  government  an 
appropriate  place  in  the  medical  field.  How- 
ever, I do  believe  that  the  medical  profession 
owes  a substantial  debt  to  the  voluntary 
health  agencies  for  helping  to  preserve  the 
primary  interests  of  private  medicine  in 
matters  of  health. 

By  providing  independent  leadership  and 
by  giving  counsel  to  governmental  health 
agencies,  such  as  the  National  Institutes  of 
Health,  the  voluntary  agencies  have  helped, 
not  only  to  maintain  the  integrity  of  the  med- 
ical profession,  but  also  to  channel  the  health 
activities  of  government  into  their  proper 
areas  and  functions.  The  National  Institutes 
of  Health  have  not  suffered;  on  the  contrary 
they  have  profited  through  the  existence  of 
the  voluntary  health  agencies.  They  did  and 
still  do  look  to  these  agencies  to  pioneer,  to 
experiment,  and  to  show  the  way  in  explor- 
ing the  health  needs  of  the  nation. 

The  voluntary  health  agencies  also  serve  as 
a powerful  channel  through  which  the  value 
of  the  work  and  achievements  of  the  medical 
profession  and  research  investigators  is  made 
known  to  the  public.  Every  agency,  as  a mat- 
ter of  policy,  says  to  the  public  over  and  over 
again:  “See  your  own  physician;  he  is  your 
best  protection  against  disease.” 

Realizing  that  a doctor  cannot  ethically  re- 


mind his  patients  that  they  need  him,  the 
health  agencies  can  and  do.  They  extol  the 
family  doctor  as  the  first  and  best  line  of  de- 
fense against  disease  and  death,  and  they 
back  him  up  with  research,  education  and 
community  service. 

It  is  ironical,  therefore,  that  United  Funds 
have  focused  attention  on  the  local  physician 
and  the  local  medical  society  as  a point  of 
attack  in  promoting  their  campaigns.  What 
usually  happens  in  a community  is  this: 

A small  body  of  citizens,  usually  local  bus- 
iness executives,  either  self-motivated  or  per- 
suaded by  professional  representatives  of 
United  Funds,  become  annoyed  by  “so  many 
drives,”  and  it  is  decided  to  reduce  the  num- 
ber of  these  drives.  The  national  organiza- 
tion, known  as  the  United  Community  Funds 
and  Councils,  then  sends  out  information  and 
workers  to  instruct  the  local  group.  With  or 
without  a preliminary  “survey,”  these 
workers  come  up  with  the  surprising  answer 
that  the  public  is  in  revolt  against  so  many 
drives,  and  that  a United  Fund  Plan  of  “One 
gift  for  all — one  campaign  for  all”  will  solve 
all  the  local  charity  and  welfare  problems. 

The  local  group  are  glad  to  believe  that  this 
is  the  answer  to  their  problem,  part  of  which 
usually  includes  the  fact  that  the  local  Com- 
munity Chest  has  been  faltering,  not  to  say 
failing.  They  are  particularly  glad  to  believe 
in  the  United  Fund  plan  when  they  are 
further  told  how  easy  it  will  be.  “No  more 
door-to-door  solicitations  by  weary  volun- 
teers; no  more  high-powered  campaigns  by 
a multitude  of  drives,”  they  are  told;  “merely 
a single  payroll  check-off  in  industrial  plants 
and  places  of  work  and  the  job  is  done  for 
you.” 

On  this  basis,  the  local  group  enthusiastic- 
ally set  out  to  establish  a United  Fund.  Short- 
ly, however,  they  begin  to  run  into  difficul- 
ties. Cancer,  Heart,  and  Polio,  for  valid 
reasons  of  national  policy,  decline  to  partici- 
pate in  the  local  United  Fund  campaign.  And 
so  a struggle  is  precipitated. 

Those  who  start  out  believing  that  their 
objective  is  to  obtain  funds  more  easily  for 
many  good  causes,  suddenly  find  themselves 
attacking  some  of  those  very  causes.  As  one 
point  of  attack,  they  focus  on  individual  phys- 
icians or  on  local  medical  societies  in  an  effort 
to  induce  them  to  endorse  the  United  Fund. 
They  use  many  devices,  including  personal 


— 101  — 


SOUTH  DAKOTA 


influence  and  organizational  pressure,  to  ac- 
complish their  purpose. 

United  Fund  people  often  blame  the  pre- 
vious failures  of  the  Community  Chest  on  the 
health  agencies.  “Here,”  they  say,  “is  the 
reason  we  have  been  failing:  the  health  agen- 
cies have  been  siphoning  off  funds  from  our 
community.”  (They  conveniently  forget  that 
never  in  a single  year  have  all  the  national 
voluntary  health  agencies  combined  received 
a per  capita  contribution  of  more  than  $1 
from  the  American  people.)  “People  just 
now  happen  to  be  interested  in  health,”  they 
say;  “it’s  a popular  cause  at  the  moment.  We 
need  it  in  our  campaign  to  obtain  enough 
money.  The  health  agencies  must  go  along 
with  us,  or  we’ll  set  up  our  own  health  causes 
and  collect  the  money  ourselves.  After  all, 
heart,  cancer,  polio,  and  the  rest  are  just  di- 
seases and  one  cannot  trade-mark  a disease.” 

And  so  they  set  up  a health  “cause”  solici- 
tation as  part  of  their  campaign,  leaving  the 
public  to  believe  that  the  Heart  Association, 
the  Cancer  Society,  or  the  Polio  Foundation 
will  actually  receive  the  funds,  despite  ad- 
vance public  declarations  by  the  voluntary 
agencies  that  they  must  decline  such  funds 
and  will  continue  to  conduct  their  independ- 
ent campaigns.  Ironically,  in  the  process. 
United  Fund  promoters  do  what  they  pro- 
fess to  abhor;  they  establish  yet  another 
agency! 

The  pressures  brought  to  bear  by  the 
United  Fund  people  upon  the  voluntary 
health  agencies  in  this  connection  have  been 
almost  incredible.  They  have  openly  pro- 
claimed that  rough  pressure  methods  “with 
teeth  in  them”  will  be  used  against  the  agen- 
cies that  do  not  participate  in  local  United 
Funds.  Their  tactics  have  included  economic 
threats  against,  and  boycotts  of,  many  private 
individuals,  as  well  as  business  organizations. 
Thus  they  tell  the  public  not  only  how  to  give, 
but  where  to  give,  when  to  give,  and  often 
how  much  to  give. 

In  the  face  of  such  tactics,  the  national  vol- 
untary health  agencies  have  been  hard 
pressed  to  protect  themselves.  They  have  not 
wished  to  launch  a counterattack,  believing 
that  two  wrongs  do  not  make  a right,  and  be- 
sides they  do  not  wish  to  fight  United  Funds. 
They  have  resorted  heretofore  merely  to  pas- 


sive resistance,  relying  on  the  American 
people  to  recognize  in  time  the  value  of  the 
independent  way  and  to  find  a solution  other 
than  regimentation. 

Whether  we  like  it  or  not,  the  medical  pro- 
fession is  directly  involved  in  this  controv- 
ersy. Medicine  cannot  continue  to  ignore  or 
condone  the  threats  to  itself  through  the  in- 
creasing attacks  by  United  Funds  on  the  vol- 
untary health  agencies.  For  United  Funds 
are  promoting  a movement  under  which  un- 
informed, though  conceivably  well  inten- 
tioned,  local  laymen  are  entering  directly 
into  national  medical  fields  of  health  and 
disease  and  deciding  where  and  when  funds 
should  be  spent  for  each  purpose,  and  how 
much.  United  Fund  people  may  understand 
local  charity  needs,  but  they  know  nothing 
about  the  requirements  of  the  nationally  co- 
ordinated programs  of  medical  research  being 
conducted  by  the  voluntary  health  agencies. 

During  its  early  years,  the  Heart  Associa- 
tion participated  in  over  450  United  Funds, 
and  sadly  learned  not  only  that  the  amounts 
collected  were  inadequate,  but  also  that  de- 
votion and  zeal  were  lost  even  among  dedi- 
cated Heart  Volunteers  when  they  succumbed 
to  the  siren  song  of  “Once  for  all.” 

Today  the  Heart  Association  has  withdrawn 
from  all  but  270  of  these  Funds.  Based  on  the 
per  capita  giving  in  the  remaining  Funds,  the 
Heart  Association  in  1957  would  have  raised 
less  than  half  the  amount  it  did  raise  had  it 
participated  in  a United  Fund  everywhere. 
It  therefore  becomes  forcefully  apparent  that 
the  Heart  program  would  have  suffered  a 
serious  setback  in  research,  not  to  mention  all 
other  phases  of  its  work,  had  the  Heart  Asso- 
ciation been  forced  to  abandon  its  independ- 
ence under  coercion  by  the  United  Funds. 

Fund  raising,  except  by  taxation,  is  not 
easy;  indeed  it  should  not  be  easy.  Com- 
petition is  the  American  way.  Health  needs 
like  other  needs  must  compete  for  public  sup- 
port. The  law  of  supply  and  demand  cannot 
be  repealed,  and  the  Heart  Association  is  will- 
ing to  accept  this  fact.  We  believe  that  the 
people  will  continue  to  supply  the  funds  as 
long,  but  only  as  long,  as  a major  health  need 
exists.  When  the  cardiovascular  diseases  are 
conquered,  the  Heart  Association’s  work  will 
be  done. 

(Continued  on  Page  106) 


— 102  — 


MARCH  1958 


SOUTH  DAKOTA  STATE  MEDICAL 
ASSOCIATION 
COUNCIL  MEETING 
January  19,  1958 


The  January  meeting  of  the  Council  of  the 
South  Dakota  State  Medical  Association  was 
held  in  Huron,  January  19,  at  the  Marvin 
Hughitt  Hotel.  The  meeting  was  called  to 
order  by  Dr.  Davidson  at  1:00  P.M.  The  fol- 
lowing members  answered  the  roll  call:  Drs. 
Morrissey,  Buchanan,  Reding,  Peeke,  Stran- 
sky,  Davidson,  Askwig,  Hohm,  Brogdon, 
Johnson,  and  Mr.  Foster.  Absent:  Drs.  Lam- 
pert,  Stoltz,  McCarthy,  Sattler,  Hayes,  Tor- 
kildson,  and  McDonald.  A quorum  was  de- 
clared present. 

Dr.  Peeke  moved  that  the  reading  of  the 
minutes  of  the  last  meeting  be  dispensed 
with  as  they  had  been  published  in  the  Jour- 
nal. Dr.  Reding  seconded  the  motion  and  it 
was  passed. 

Mr.  Foster  discussed  the  opinions  given  by 
the  Chairman  of  the  Committee  on  Diabetes 
and  the  Public  Health  Committee  Chairman 
on  Blood  Testing  by  the  State  Health  Depart- 
ment for  Detection  of  Diabetes  at  the  State 
Fair.  Dr.  Stransky  moved  that  inasmuch  as 
this  was  not  a Public  Health  function,  it  is 
recommended  to  the  Health  Department  that 
the  program  be  discontinued.  Dr.  Askwig 
seconded  the  motion,  and  it  was  carried. 

Dr.  Askwig  moved  that  the  Medical  Eco- 
nomics Committee  recommendation  on  the 
Group  Life  Insurance  Program  be  adopted 
and  put  into  effect.  Motion  seconded  by  Dr. 
Buchanan  and  carried.  The  recommendation 
is  as  follows:  That  the  Council  revision  of  the 
present  group  life  insurance  plan  to  break 
down  rates,  giving  the  younger  men  a lower 
rate  than  has  now  been  possible. 

Mr.  Foster  explained  the  action  taken  by 
the  Committee  on  Medical  Economics  on 
Physicians  Liability.  Dr.  Peeke  moved  that 
each  District  Medical  Society  investigate 
what  the  physicians  in  their  District  are  pay- 
ing now  for  Physicians  Liability,  and  that 
this  information  be  brought  back  at  the  next 
meeting.  This  motion  was  seconded  by  Dr. 
Buchanan  and  carried. 

Mr.  Foster  discussed  the  Radiation  Protec- 
tion Act  which  the  Committee  on  Public 
Health  had  considered.  No  action  taken. 


Dr.  Stransky  moved  that  the  recommen- 
dation of  the  Medical  Economics  Committee 
on  Group  Loss  of  Time  Program  be  adopted. 
Motion  was  seconded  by  Dr.  Reding  and 
carried.  The  recommendations  are  as  follows: 

1.  That  more  study  be  given  the  group  loss 
of  time  plans  as  submitted  by  the  various 
companies  and  that  Mr.  Diers  make  an 
earnest  effort  to  increase  enrollment  in  the 
present  plan  to  make  it  a true  group. 

2.  That  no  expansion  of  the  present  plan  of 
group  disability  coverages  be  considered 
until  true  group  proportions  have  been  en- 
rolled. Mr.  Foster  discussed  the  proposed 
program  for  the  Annual  Meeting. 

No  action. 

Dr.  Buchanan  moved  that  the  Medical  As- 
sociation appropriate  $500.00  for  the  Basic 
Science  Board  for  the  prosecution  of  illegal 
practitioners,  any  further  action  to  be  taken 
by  the  House  of  Delegates  at  the  annual 
meeting.  Motion  was  seconded  by  Dr.  Stran- 
sky, and  carried. 

Mr.  Foster  discussed  the  progress  of  the 
Committee  on  Indigent  Care.  No  action. 

Dr.  Stransky  moved  that  the  recommen- 
dation from  the  Medical  School  Affairs  Com- 
mittee be  adopted.  This  motion  was  seconded 
by  Dr.  Peeke,  and  carried.  The  recommen- 
dation is  as  follows:  That  a Poison  Registry 
Center  be  established  at  the  University  of 
South  Dakota,  and  that  wide  spread  publicity 
be  given  to  South  Dakota  doctors  on  this 
matter. 

Dr.  Buchanan  moved  that  the  recommen- 
dation from  the  Legislation  Committee  be 
adopted.  Seconded  by  Dr.  Reding,  the  mo- 
tion was  carried. 

The  recommendation  is  as  follows: 
WHEREAS,  provision  of  medical  care  for  the 
aged  is  a serious  social  economical  problem 
facing  society  today,  and 
WHEREAS,  the  American  System  of  private 
enterprise  has  in  the  past  been  able  to  solve 
problems  of  this  nature,  and 
WHEREAS,  the  interest  of  Federal  Govern- 
ment has  already  been  evidenced  in  bills  now 
pending  before  Congress,  now  therefore 


— 103  — 


a new  era 


SUUFAMETHOXYPYRIDAZINE  ( 3-S ULFANILAMI DO-6-METHOXYPYR1 DAZIN e)  LEDERLE 


New  authoritative  studies  prove  that  Kynex  dosage  can  be  reduced  even  / 
further  than  that  recommended  earlier.^  Now,  clinical  evidence  has  established  ; 
that  a single  (0.5  Gm.)  tablet  maintains  therapeutic  blood  levels  extending  |;| 
beyond  24  hours.  Still  more  proof  that  Kynex  stands  alone  in  sulfa  per- 
formance—  '| 

• Lowest  Oral  Dose  In  Sulfa  History— 0.5  Gm.  (1  tablet)  daily  in  the  usual  | 
patient  for  maintenance  of  therapeutic  blood  levels 

• Higher  Solubility— effective  blood  concentrations  within  an  hour  or  two  ' 

• Effective  Antibacterial  Range— exceptional  effectiveness  in  urinary  tract  I 

infections  i 

• Convenience— the  low  dose  of  0.5  Gm.  (1  tablet)  per  day  offers  optimum  | 
convenience  and  acceptance  to  patients 

NEW  DOSAGE.  The  recommended  adult  dose  is  1 Gm.  (2  tablets  or  4 teaspoon-  J 
fuls  of  syrup)  the  first  day,  followed  by  0.5  Gm.  ( 1 tablet  or  2 teaspoonfuls  of  i! 
syrup)  every  day  thereafter,  or  1 Gm.  every  other  day  for  mild  to  moderate  ii 
infections.  In  severe  infections  where  prompt,  high  blood  levels  are  indicated,  y 
the  initial  dose  should  be  2 Gm.  followed  by  0.5  Gm.  every  24  hours.  Dosage  ; j 
in  children,  according  to  weight;  i.e.,  a 40  lb.  child  should  receive  14  of  the  '! 
adult  dosage.  It  is  recommended  that  these  dosages  not  be  exceeded.  1 1 

TABLETS:  Each  tablet  contains  0.5  Gm.  (714  grains)  of  sulfamethoxypyri-  ;'j 
dazine.  Bottles  of  24  and  100  tablets.  |j 

SYRUP:  Each  teaspoonful  (5  cc.)  of  caramel-flavored  syrup  contains  250  mg. 
of  sulfamethoxypyridazine.  Bottle  of  4 fl.  oz. 

1.  Nichols,  R.  L.  and  Finland,  M.:  J.  Clin.  Med.  49:410,  1957. 

LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 
*Reg.  U.  S.  Pat.  Off. 


SOUTH  DAKOTA 


BE  IT  RESOLVED,  that  the  Council  of  the 
South  Dakota  State  Medical  Association,  tak- 
ing cognizance  of  the  seriousness  of  this  situa- 
tion, urges  Blue  Cross  and  Blue  Shield  plans 
and  private  accident  and  health  insurance 
companies  to  develop  new  contracts  that 
will  provide  suitable  benefits  for  the  aged, 
and 

BE  IT  FURTHER  RESOLVED  that  the  South 
Dakota  State  Medical  Association  pledges  its 
interest  and  support  to  Blue  Cross  and  Blue 
Shield  plans  and  private  accident  and  health 
insurance  companies  in  the  development  of 
this  extended  coverage  and  in  their  efforts  to 
make  these  benefits  available  to  the  aged 
population. 

BE  IT  FINALLY  RESOLVED  that  a copy  of 
this  resolution  be  transmitted  to  the  Blue 
Cross  and  Blue  Shield  plans  in  South  Dakota, 
private  health  insurance  carriers  located  in 
South  Dakota,  and  American  Medical  Asso- 
ciation. 

Dr.  Brown  discussed  the  Forand  Bill. 

Dr.  Peeke  moved  that  Dr.  Lamport  and  Mr. 
Foster  represent  the  SDSMA  May  12,  and  13, 
in  negotiation  on  the  Medicare  contract,  and 
that  they  do  not  take  a signed  contract  with 
them,  but  return  for  approval.  This  motion 
was  seconded  by  Dr.  Morrissey,  and  if  was 
carried. 

Dr.  Buchanan  moved  that  the  executive 
secretary  be  authorized  to  purchase  a medium 
priced  car,  not  to  exceed  $3600.00,  and  that 
credit  cards  be  issued  to  the  Medical  Associa- 
tion and  Blue  Shield  so  that  all  expenses  will 
be  put  on  these  cards.  Dr.  Askwig  seconded 
the  motion  and  it  was  carried. 

Dr.  Morrissey  moved  that  it  be  recom- 
mended to  the  Blue  Shield  Board  that  the 
executive  secretary  receive  $150.00  a month 
for  services  rendered  the  Medicare  program. 
Dr.  Peeke  seconded  the  motion,  and  it  was 
carried. 

Dr.  Bailey  moved  that  F.  S.  Howe,  M.D.,  be 
made  an  honorary  member  of  the  South 
Dakota  State  Medical  Association.  This  mo- 
tion was  seconded  by  Dr.  Buchanan  and 
carried. 

Dr.  Bailey  moved  that  C.  A.  Soe,  M.D.,  be 
made  an  honorary  member  of  the  South  Da- 
kota State  Medical  Association.  This  motion 
was  seconded  by  Dr.  Reding  and  it  was  car- 
ried. 

Dr.  Morrissey  moved  that  Dr.  Robert  Van 
Demark  be  named  acting  editor  of  the  Jour- 


nal until  May  1958,  when  Mayer’s  term  would 
have  expired,  and  that  each  Councilor  should 
check  with  their  members  to  determine  in- 
terest in  the  position.  This  motion  was  sec- 
onded by  Dr.  Peeke  and  it  was  carried. 

Dr.  Stransky  moved  that  the  Medical  Asso- 
ciation donate  $100.00  to  the  Science  Fairs 
in  1958.  Dr.  Reding  seconded  the  motion  and 
it  was  carried. 

Dr.  Reding  moved  that  the  Medical  Eco- 
nomics Committee  contact  a like  committee 
of  the  Hospital  Association  to  study  the  prob- 
lem of  professional  liability.  Dr.  Johnson  sec- 
onded the  motion  and  it  was  carried. 

Dr.  Morrissey  moved  that  the  South  Dakota 
State  Medical  Association  adopt  the  resolu- 
tion introduced  at  the  AMA  Interim  Session 
by  Dr.  Carl  S.  Mundy  on  rural  health.  Dr. 
Buchanan  seconded  the  motion  and  it  was 
carried. 

The  resolution  is  as  follows: 

WHEREAS,  in  the  past  twelve  years  the 
American  Medical  Association  and  the  sev- 
eral state  medical  associations  have  made 
outstanding  progress  in  better  relationships 
with  the  major  national  and  state  farm  or- 
ganizations; and 

WHEREAS,  These  relationships  have  been 
built  up  by  discussions  of  programs  of  mutual 
interests  and  help  fullness;  and 
WHEREAS,  Organized  medicine  and  these 
rural  groups  have  much  in  common  in  pre- 
serving the  free  enterprise  system;  and 
WHEREAS,  There  is  still  much  to  be  achieved 
in  further  cementing  our  relationships  with 
local  farm  groups;  therefore  be  it 
RESOLVED,  That  the  House  of  Delegates 
urge  each  state  medical  association  to  give 
greater  support  and  encouragement  to  its 
rural  health  committee  in  its  work  with  state 
farm  organization  and  rural  groups,  and  en- 
courage said  committee  to  ask  county  med- 
ical societies  to  appoint  a physician  or  a com- 
mittee of  physicians  to  form  a closer  liaison 
with  and  work  with  all  local  farm  organiza- 
tions and  rural  groups. 

Dr.  Morrissey  moved  that  Dr.  Lampert  be 
named  President  of  the  North  Central  Con- 
ference to  fill  the  vacancy  created  by  the 
death  of  Dr.  Mayer.  The  motion  was  sec- 
onded by  Dr.  Peeke.  Motion  carried. 

Dr.  Peeke  moved  that  Dr.  Lampert  be 
named  from  South  Dakota  to  serve  on  the 
(Continued  on  Page  107) 


=-  104  — 


«CAL  LIBRARY  BOOKSHELF 


NOBEL  PRIZES 

The  Nobel  Prizes  — five  cash  prizes  of 
$40,000,  a recognition  certificate,  and  a me- 
dallion bearing  the  likeness  of  Nobel  on  the 
front  and  a symbolic  representation  of  the 
recipient’s  field  of  endeavor  on  the  reverse 
side  — are  awarded  for  Physics,  Medicine  and 
Physiology,  Chemistry,  Literature,  and  Peace 
annually  on  December  10th,  the  anniversary 
of  the  death  of  Nobel  on  December  10th,  1896. 

The  will  of  Alfred  Bernhard  Nobel,  a Swed- 
ish chemist,  provided  that  the  major  portion 
of  his  fortune,  amassed  mainly  from  the  129 
patents  for  nitrocellulose  and  a smokeless 
powder,  the  percursor  of  cordite,  should 
be  invested  by  the  executors  in  reliable  secur- 
ities thereby  forming  a fund,  the  interest  of 
which  was  to  be  distributed  annually  “in  the 
form  of  prizes  among  those  who  have,  within 
the  respective  twelve  month  successively 
elapsed,  rendered  the  greatest  service  to  man- 
kind.” The  prizes  were  to  be  awarded  by  the 
following  agencies:  physics  and  chemistry  by 
the  Swedish  Academy  of  Sciences;  medicine 
or  physiology  by  the  Carolinian  Institution  in 
Stockholm;  literature  by  the  Academy  of 
Stockholm,  and  peace  by  a five  man  com- 
mittee elected  by  the  Norwegian  Storting 
(Parliament). 

All  of  the  distributing  bodies  have  Nobel 
committees  from  three  to  five  persons  and 
special  scientific  bodies  called  Nobel  Institu- 
tions. These  committees  examine  the  sugges- 
tions submitted  to  them  and  express  their 
opinion  as  to  the  prize  allotments.  These  sug- 
gestions must  be  submitted  in  writing  sub- 
stantiated in  detail  and  accompanied  by  the 
candidates  publications.  The  principle  cate- 
gories of  those  elegible  to  submit  the  names 
of  candidates  are  the  following;  members  of 


the  distributing  bodies;  members  of  the  Nobel 
committees;  former  Nobel  prize  winners; 
authorized  university  and  college  faculties, 
and,  for  the  peace  prize,  members  of  govern- 
ment or  international  organizations. 

Nobel  Prize  Winners  in  Medicine  and  Phys- 
iology 1901-1950  edited  by  Lloyd  G.  Steven- 
son, Schuman,  1952,  gives  biographical 
sketches,  as  well  as  information  about  the  re- 
search carried  on  by  each  recipient,  their 
main  contribution  to  the  field  of  medicine, 
and  a description  of  the  prize-winning  work. 

According  to  Science,  volume  126,  Novem- 
ber 15,  1957,  the  Nobel  Prize  for  Physiology 
and  Medicine  for  1957  was  awarded  to  Pro- 
fessor Daniel  Bovet,  aged  50  and  head  of  the 
Department  of  Pharmacology  at  the  Institute 
Superiore  di  Sanita  in  Rome.  Swiss  born,  he 
became  a naturalized  Italian  citizen  in  1947 
and  is  the  first  Italian  to  win  the  prize  since 
1906.  Professor  Bovet  was  an  early  student 
of  antihistamine  compounds  and  discovered 
their  chemical  structure.  Then  he  turned  to 
the  problem  of  muscle  relaxants.  He  an- 
alyzed the  Brazilian  arrow  poison,  used  by  the 
South  American  Indians  to  poison  darts,  and 
developed  a series  of  synthetic  curare  drugs 
that  are  now  considered  landmarks  in  the  his- 
tory of  anesthetics,  one  of  which  is  succinyl- 
choline  now  in  general  use  as  a muscle  relax- 
ant during  surgery  on  the  chest  and  abdomen. 
Currently  he  is  interested  in  the  chemistry 
of  the  brain  and  its  relation  to  mental  illness. 
The  award  was  for  his  discoveries  in  syn- 
thetic curare  compounds. 

A recent  article,  with  Professor  Bovet  as 
co-author,  appears  in  the  Journal  of  Pharma- 
cology and  Experimental  Therapeutics,  vol- 
ume 118,  1956,  page  63,  entitled  “Action  of 
histamine  on  the  jugular  venous  pressure  and 


— 105  — 


SOUTH  DAKOTA 


cerebral  circulation  of  dogs.  Effects  of  anti- 
histaminic  drugs  (pyrilamine  and  chlorpheni- 
ramine) and  a histamine  liberating  agent 
(48/80  B.  W.).”  The  findings  reported  in  this 
paper  appear  to  confirm  in  the  animal  the 
observations  in  man  made  by  Weiss,  Lennox, 
and  Robb  (1928),  which  twenty-five  years  ago 
attracted  attention  to  the  fact  that  “the  sensi- 
tivity of  the  cerebral  vessels  to  histamine 
(and  epinephrine)  suggest  that  these  chem- 
ical substances  through  their  local  action  may 
play  a role  in  the  physiologic  and  pathologic 
regulation  of  the  cerebral  circulation  in  man.” 

According  to  the  Scientific  American,  vol- 
ume 197,  Dec.,  1957,  page  59,  the  1957  physics 
winners  (among  the  youngest  men  even  to 
receive  the  Nobel  Prize)  were  the  Chinese- 
born,  not  United  States  citizens,  theoretical 
physicists,  Chen  Ning  Yang,  34,  of  the  Insti- 
tute for  Advanced  Study  at  Princeton,  and 
Tsung  Dao  Lee,  30,  of  Columbia  University. 
They  challenged  the  “law”  of  conservation  of 
parity  and  suggested  the  experiment  that 
proved  they  were  right. 

The  prize  for  chemistry  went  to  Sir  Alexan- 
der Todd,  50  and  Professor  of  Organic  Chem- 
istry at  Cambridge  University,  for  his  work 
on  Nucleotide  coenzymes  and  the  determina- 
tion of  the  fundamental  chemical  structure 
of  the  nucleic  acids.  He  was  the  first  to  syn- 
thesize a number  of  important  nucleotides  in- 
cluding adenosine  diphosphate  and  adenosine 
triphosphate. 

According  to  Science,  volume  126,  Septem- 
ber 6,  1957,  page  459,  the  Nobel  laureates  in 
medicine,  chemistry,  and  physics  meet  an- 
nually at  Lindau,  Bavoria  and  lecture  on 
their  particular  fields  of  interest.  The  city  of 
Lindau  and  Count  Bernadotte  act  as  hosts.  A 
large  number  of  instructors,  assistants  from 
various  scientific  institutions,  and  graduate 
students  in  German  and  foreign  universities 
are  invited  to  attend  these  meetings.  Among 
the  United  States  participants  in  1957  were 
the  following  and  the  topics  they  presented: 
P.  S.  Hench  of  Rochester,  Minnesota,  “The 
chemical  and  experimental  use  of  cortisone;” 
W.  M.  Stanley  of  Berkeley,  California,  “Re- 
lations between  virus  and  cancer;”  Selman  A. 
Waksman,  of  Rutgers  State  University,  “Anti- 
biotics and  their  social  significance.” 

A very  distinguished  graduate  of  this  Uni- 
versity, Dr.  Ernest  Orland  Lawrence,  born  in 


Canton,  South  Dakota,  received  the  Noble 
prize  for  physics  in  1939. 

Mrs.  Esther  Howard 
Medical  Librarian 


The  Diagnosis  and  Treatment  of  Vaginal 
Bleeding  During  Pregnancy — 

(Continued  from  Page  90) 

19.  Ratnoff,  O.  D.:  New  England  J.  Med.  253:  63; 

97  1955 

20.  Roddie,  T.  W.:  Brit.  M.  J.  1:  890,  1956 

21.  Schnitz,  H.  E.,  O’Dea,  N.  J.,  and  Isaacs,  J.  H.; 

Obst.  & Gynec.  3:  3,  1954 

22.  Speert,  H.,  and  Guttmacker,  A.  F., 

J.A.M.A.  155:  712,  1954 

23.  Thomas,  E.  W.;  J.A.M.A.  162:  1536,  1956 

24.  Turnbull,  E.  P.,  and  Walker,  J.:  J.  Obst.  & 

Gynec.  Brit.  Emp.  63:  553,  1956 

25.  Word,  B.:  Obst.  & Gynec.  8:  627,  1956 


MEDICAL  ECONOMICS— 

(Continued  from  Page  102) 

In  the  meantime,  may  I remind  you,  my 
medical  colleagues,  that  the  Heart  Associa- 
tion, and  the  other  ethical  national  voluntary 
health  agencies,  are  performing  vital  services 
for  you.  They  are  telling  your  story  to  the 
public;  they  are  protecting  you  from  govern- 
mental domination  on  one  side,  and  from 
local  dictatorship  on  the  other.  But  most  im- 
portant, along  with  you  they  are  leading  the 
way  towards  the  control  of  the  major  chronic 
diseases. 

If  United  Funds  are  permitted  to  continue 
to  undermine  these  efforts  of  the  voluntary 
health  agencies,  research  will  dwindle  and 
the  conquest  of  disease  inevitably  will  be  de- 
layed. The  result  will  be  the  needless  loss  of 
hundreds  of  thousands  of  lives. 

Every  physician  should  give  most  thought- 
ful consideration  to  the  problems  created  by 
the  United  Fund  philosophy  and  tactics.  Free- 
dom is  indivisible.  It  is  for  all,  or  for  none. 
The  medical  profession  will  help  to  preserve 
its  own  freedom  in  the  future  if  it  insists  now, 
through  its  county,  state,  and  national  organ- 
izations, that  the  ethical  voluntary  health 
agencies  be  freed  of  further  coercion  by 
United  Funds. 

Individual  doctors,  who  wish  to  interest 
themselves  and  their  patients  directly  in  the 
work  of  the  Heart  Association,  will  receive 
not  only  an  enthusiastic  welcome,  but  also 
the  satisfaction  of  contributing  in  an  import- 
ant way  to  a volunteer  group,  whose  sole 
purpose  is  to  help  all  physicians  in  their  fight 
against  disability  and  death. 


— 106  — 


MARCH  1958 
ANESTHESIOLOGY— 

(Continued  from  Page  96) 
from  the  anesthesiologist? 

He  may  visit  you  in  your  room  before  the 
operation,  at  the  request  of  your  surgeon, 
who  already  will  have  talked  to  him  about 
your  condition  and  general  state  of  health. 

The  anesthesiologist  will  study  your  chart, 
review  your  medical  history  and  probably 
talk  over  the  proposed  anesthesia.  If  you  are 
overly  nervous,  he  will  use  his  skill  and  ex- 
perience to  relieve  your  apprehension. 

You  enter  the  operating  room  surprisingly 
relaxed  by  the  premedication  which  the  anes- 
thesiologist has  prescribed  for  you. 

He  again  checks  your  mental  state,  blood 
pressure,  pulse,  and  other  important  details. 
Then  he  gives  you  the  anesthetic  drugs  which 
he  and  your  surgeon  have  selected  for  you. 

As  the  surgeon  begins  to  operate,  the  anes- 
thesiologist keeps  a continuous  watch  over 
the  action  of  your  heart  and  lungs.  He  may 
decide  to  administer  blood,  plasma  or  dex- 
trose. He  becomes  the  guardian  of  your  whole 
being  beyond  the  region  in  which  the  surgeon 
is  operating. 

In  an  emergency,  the  judgment  of  the  anes- 
thesiologist may  require  him  to  change  the 
anesthetic  being  used  while  the  operation  is 
still  under  way.  The  operation  may  be  de- 
layed or  even  halted  in  response  to  his  judg- 
ment, until  he  is  able  to  restore  your  psysio- 
logic  condition  more  nearly  to  normal. 

Following  the  operation,  you  awaken 
quickly,  often  surprised  that  the  anesthesia 
has  left  little  after  effect.  You  are  unaware 
whether  the  anesthesiologist  has  treated  you 
to  prevent  shock  or  even  has  literally 
“breathed  for  you”  while  you  were  unable 
to  do  it  satisfactorily. 

much  as  provision  for  this  has  already  been 

His  treatment  probably  has  included  drugs 
to  relax  your  muscles  and  allow  the  surgeon 
to  operate  with  greater  feedom,  and  many 
other  things  to  help  bring  you  safely  through 
the  operation.  He  has  watched  over  you  fol- 
lowing the  operation  as  well. 

In  brief,  your  anesthesiologist  has  served 
you  not  as  a white-garbed  and  impersonal  in- 
dividual, glimpsed  momentarily  before  the 
anesthetic  is  administered,  but  as  a full  mem- 
ber of  the  operating  or  obstetric  team,  whose 
presence  and  skill  are  left  throughout  your 
stay  in  the  hospital. 

In  addition  to  removing  the  factor  of  limi- 

—107 


tation  from  the  surgeon’s  work  in  compli- 
cated cases  ,the  anesthesiologist  is  of  service 
in  all  other  anesthetic  procedures. 

COUNCIL  MEETING— 

(Continued  from  Page  104) 

Advisory  Committee  of  the  North  Central 
Conference  for  the  AMA  Interim  Session. 
The  motion  was  seconded  by  Dr.  Reding  and 
carried. 

Dr.  Peeke  moved  that  the  executive  secre- 
tary be  instructed  to  check  on  material  that 
could  be  given  out  at  the  Hospitality  room 
of  the  North  Central  Conference  states  at 
the  Interim  Session  of  the  AMA,  which  will 
be  held  in  Minneapolis  this  year.  The  mo- 
tion was  seconded  by  Dr.  Reding  and  carried. 

Dr.  Argabrite  was  unable  to  appear  before 
the  Council  to  discuss  the  use  of  penicillin  for 
prophalactic  treatment  of  rheumatic  fever. 
Dr.  Buchanan  moved  that  the  matter  be  laid 
on  the  table  until  the  next  meeting  and  to  in- 
vite Dr.  Argabrite  to  attend.  Dr.  Bailey 
seconded  the  motion,  and  it  was  carried. 

Dr.  Peeke  moved  that  the  Committee  on 
Coroner’s  Law  be  continued  for  another  year. 
Motion  seconded  by  Dr.  Stransky,  and  car- 
ried. 

Dr.  Peeke  moved  that  the  Committee  on 
Coroner’s  Law  revise  and  present  a Coroner’s 
law  to  the  Legislative  Research  Council. 
Motion  was  seconded  by  Dr.  Reding,  and  it 
was  carried. 

Dr.  Reding  moved  that  the  Council  urge 
the  continuation  of  the  refresher  courses  at 
the  University.  Dr.  Morrissey  seconded  the 
motion,  and  it  was  carried.  No  action  was 
taken  on  the  recommendation  from  the  Med- 
ical School  Affairs  Committee  for  the  alloca- 
tion of  students  scholarships  and  $50.00  to 
help  defray  cost  of  a student  to  SAMA  inas- 
made  in  the  budget. 

Dr.  Brogdon  moved  that  the  Council  en- 
dorse the  lung  cancer  survey  of  the  USPHS. 
Motion  seconded  by  Dr.  Morrissey.  Motion 
carried. 

The  recommendations  presented  to  the 
Liason  Committee  with  the  Pharmaceutical 
Association  were  discussed.  Dr.  Stransky 
moved  that  questions  5 and  6 of  these  recom- 
mendations be  referred  back  to  the  commit- 
tee for  further  study  and  that  no  action  be 
taken  on  these  recommendations  until  such 
study  has  been  made.  Dr.  Brogdon  seconded 
the  motion.  Carried. 

The  meeting  adjourned  at  5:00  P.M. 


YANKTON  DISTRICT 
ELECTES  DR.  MONK 

The  Yankton  District  Med- 
ical Society  met  at  Yankton 
State  Hospital  Thursday, 
February  6,  at  which  time 
they  elected  Dr.  Robert 
Monk  as  president  for  the 
coming  year;  Dr.  Amos  Mi- 
chael, Vice-president;  Dr. 
W.  F.  Stanage,  Secretary;  and 
Dr.  Hugo  Andre,  Treasurer. 
The  scientific  speaker  was 
Dr.  Robert  Nelson  of  Sioux 
Falls,  who  discussed  “Non- 
Penetrating  Injuries  of  the 
Chest.”  Executive  Secretary 
Foster  discussed  indigent 
care  proposals.  Medicare,  and 
Blue  Shield. 


LICENSE  BOARDS 
MEET  IN  CHICAGO 

The  Federation  of  State 
Licensing  Boards  met  at  the 
Palmer  House  in  Chicago 
February  9-11.  John  C.  Fos- 
ter, executive-secretary  of 
the  Board  represented  South 
Dakota  at  the  meetings. 

Discussions  included  “The 
Physician  As  An  Addict,” 
“Experiences  With  Probation 
in  California,”  “The  Exam- 
ination Institute”  and  other 
licensure  problems. 


DR.  MARK  COGSWELL 
RECEIVES  WOLSEY 
APPRECIATION 
Dr.  Mark  C.  Cogswell,  for 
51  years  Wolsey’s  family 
doctor,  received  the  best 
wishes  and  gratitude  of  his 
community  at  a program  in 
the  high  school  gymnasium 
Friday,  January  24th. 

Richard  Haeder  was  chair- 
man of  the  program  which 
drew  over  600  people  to  the 
event.  Haeder  introduced 
Dr.  M.  M.  Morrissey,  presi- 
dent of  the  State  Medical  As- 
sociation, Dr.  Ted  Hohm, 
president  of  the  Huron  Dis- 
trict Medical  Society,  and 
John  C.  Foster,  Association 
executive  secretary,  who 
brought  greetings  to  the 
town  of  Wolsey. 

A “This  is  Your  Life”  type 
of  program  as  well  as  a play 
were  presented  for  the  pub- 
lic’s entertainment.  A num- 
ber of  messages  were  read 
from  the  former  townspeople 
and  political  personages,  be- 
ing topped  off  by  a telegram 
from  President  Eisenhower. 

Flowers  were  presented  to 
Dr.  and  Mrs.  Cogswell  by 
their  grandchildren. 

Most  of  the  Huron  phys- 
icians were  present  to  honor 
their  colleague. 


Dr.  Cogswell  established 
practice  in  Wolsey  in  Jan- 
uary of  1907.  Still  active  in 
the  profession,  he  has  re- 
ceived fifty-year  honors  from 
the  University  of  Tennessee 
and  the  South  Dakota  State 
Medical  Association. 


OB-GYN  BOARD 
TO  EXAMINE 

The  next  scheduled  exam- 
inations (Part  II),  oral  and 
clinical  for  all  candidates 
eligible,  will  be  conducted  at 
the  Edgewater  Beach  Hotel, 
Chicago,  111.,  by  the  entire 
Board  from  May  7 through 
17,  1958.  Formal  notice  of 
the  exact  time  of  each  can- 
didate’s examination  will  be 
sent  him  in  advance  of  the 
examination  dates. 

Candidates  who  partici- 
pated in  the  Part  I Examina- 
tions will  be  notified  of  their 
eligibility  for  the  Part  II 
Examinations  at  the  earliest 
possible  date. 

Current  Bulletins  of  this 
Board  may  be  obtained  by 
writing  to: 

Robert  L.  Faulkner,  M.D. 
Secretary-Treasurer 
American  Board  of  Obste- 
trics and  Gynecology 
2105  Adelbert  Road 
Cleveland  6,  Ohio 


— 108  — 


MARCH  1958 


NEW  SPEAKERS 
BUREAU  SET 

“The  General  Practitioner 
Education  Project,  jointly 
sponsored  by  the  American 
Psychiatric  Association  and 
the  American  Academy  of 
General  Practice,  is  inter- 
ested in  the  development  of 
post-graduate  psychiatric 
education  for  the  family 
physician.  One  of  the  ser- 
vices which  is  offered  by  the 
Project  is  a Speakers  Bureau, 
which  is  prepared  to  offer 
names  of  psychiatrists  who 
are  willing  to  serve  as  guest 
lecturers  while  they  are  tak- 
ing their  vacation  trips.  Med- 
ical societies,  hospitals,  etc. 
which  are  interested  in  ob- 
taining names  of  psychiatric 
speakers  may  contact  the 
G.  P.  Project,  American  Psy- 
chiatric Association,  1785 
Massachusetts  Ave.,  N.W., 
Washington,  D.  C. 


USPHS  LISTS 
NEW  CA  TEST 

Supplement  I to  “Survey 
of  Compounds  Which  Have 
Been  Tested  For  Carcino- 
genic Activity”  is  now  avail- 
able. The  publication  lists 
981  compounds  which  were 
tested  during  the  period  1948 
through  1953.  Data  were 
collected  and  classified  by 
Professor  Philippe  Shubik 
of  the  Chicago  Medical 
School,  and  Dr.  Jonathan 
Hartwell  of  the  National 
Cancer  Institute.  Of  the 
total  number  tested,  779  are 
reported  for  the  first  time  in 
these  tests.  Copies  of  the 
new  publication  are  avail- 
able from  the  Superintend- 
ent of  Documents,  U.  S.  Gov- 
ernment Printing  Office, 
Washington  25,  D.  C.  at  $3.50 
each. 


USPHS  OFFERS 

DUTY  SPOTS 

FOR  SERVICE  YEARS 

The  Public  Health  Service 
is  offering  immediate  active 
duty  assignments  to  phys- 
icians who  qualify  for  ap- 
pointment to  the  Service’s 
Commissioned  Corps. 

Physicians  who  have  Selec- 
tive Service  obligations  to 
fulfill  can  meet  them  by 
serving  two  years  active 
duty  in  the  Commissioned 
Corps. 

Public  Health  Service  of- 
ficers receive  the  same  pay, 
allowances  and  benefits  that 
are  received  by  officers  in 
the  Armed  Forces  serving 
on  active  duty. 

The  majority  of  assign- 
ments given  to  physicians  in 
the  Public  Health  Service 
are  in  clinical  medicine  but 
a limited  number  are  avail- 
able in  research,  and  pre- 
ventive medicine  and  public 
health.  The  largest  number 
of  positions  now  available 
are  for  medical  officers  who 
are  completing  internship  or 
are  in  residency  training. 
However,  some  positions  are 
available  for  board-eligible 
or  board-certified  specialists; 
s.g.,  pathologists,  radiologists, 
psychiatrists,  internists,  sur- 
geons, and  pediatricians. 

Inquires  concerning  careers 
in  the  Public  Health  Service 
or  two  years  of  active  duty 
to  satisfy  Selective  Service 
obligations  should  be  direc- 
ted to  the  Surgeon  General, 
U.  S.  Public  Health  Service 
(P),  Washington  25,  D.  C. 


AREA  BLUE  SHIELD 
DIRECTORS  MEET 

The  District  X Blue  Shield 
Meeting  was  held  in  Chicago 
February  2,  1958.  District  X 
consists  of  six  states,  Ne- 
braska, Wisconsin,  North  Da- 
kota, South  Dakota,  Iowa, 
and  Minnesota. 

Doctor  Arthur  Offerman, 
Omaha,  and  Mr.  Don  Eagles 
of  Fargo,  North  Dakota,  were 
nominated  to  the  Blue  Shield 
Commission. 

Doctor  Fons  of  Milwaukee 
was  renamed  President  of 
District  X.  Mr.  Jo  Burger 
of  Omaha  was  renamed  as 
secretary  of  District  X.  Mr. 
John  C.  Foster  represented 
South  Dakota  at  this  meet- 
ing. The  meeting  adjourned 
at  3:45  P.M. 


HAWAII  TOUR 
SET  FOR  JUNE 

A Hawaiian  tour  sponsored 
by  the  Illinois  State  Medical 
Association  is  being  arranged 
for  persons  attending  the 
AMA  sessions  in  San  Fran- 
cisco this  June. 

Departure  from  San  Fran- 
cisco on  Pan-American  is 
scheduled  at  11:59  P.M.  with 
arrival  in  Honolula  at  7:15 
A.M.  Return  to  the  mainland 
begins  Saturday  July  5th  by 
either  boat  or  plane. 

An  additional  attraction 
will  be  a three  day  Hawaii 
Summer  Medical  Conference 
on  July  1-2-3. 

Information  on  the  tour  is 
available  from  the  Harvey  R. 
Mason  Travel  Company,  Pro- 
fessional Building,  Old  Or- 
chard, Skokie,  Illinois. 


— 109  — 


SOUTH  DAKOTA 


A.C.P.  ARRANGES 
POST-GRAD  COURSES 

The  American  College  of 
Physicians  has  announced  a 
series  of  post-graduate  cour- 
ses at  various  medical  schools 
throughout  the  country. 

“Cardiovascular  Disease” 
will  be  held  at  the  University 
of  Pennsylvania  April  14-18. 

“Current  Views  in  the 
Diagnosis  and  Treatment  of 
Cardiovascular  Diseases  in 
the  Child  and  the  Adult”  will 
be  discussed  at  the  Univer- 
sity of  Illinois  May  12-16. 

“Principles  and  Practice  of 
Internal  Medicine”  is  the 
subject  for  a course  at  the 
University  of  Iowa,  June  2-6. 

The  University  of  Roches- 
ter will  feature  “Selected 
Topics  in  Hematology  For 
Internists”  on  June  9-13. 

“Internal  Medicine”  is  the 
subject  selected  for  the  Uni- 
versity of  California  School 
of  Medicine  in  San  Francisco, 
June  16-20. 

Application  blanks  and  ad- 
ditional information  are 
available  from  E.  R.  Love- 
land, Executive  Secretary, 
American  College  of  Phys- 
icians, 4200  Pine  Street, 
Philadelphia  4,  Pa. 


NEWS  NOTES 

The  South  Dakota  Society 
of  Internal  Medicine  will 
meet  in  Rapid  City  at  the 
Sheraton-Johnson  Hotel  on 
August  30th.  Dr.  D.  L. 
Kegaries  is  program  chair- 
man. 

* * * 

Sioux  Falls  Annual  Clinic 
Day  will  be  held  at  Sioux 
Valley  Hospital  on  Septem- 
ber 3rd. 


Dr.  Paul  Hohm,  Huron, 
has  been  named  president  of 
the  St.  John’s  Hospital  Staff 

for  the  year  of  1958. 

* * * 

Dr.  Stanley  J.  Walters, 

Watertown,  returned  to  prac- 
tice in  February  after  a four 

months  illness. 

* * * 

Theodore  Wrage,  Jr.,  M.D., 

Watertown,  has  opened  an 
office  in  Castlewood  two 
days  a week. 

* * * 

A new  clinic  building  has 
been  opened  in  Burke.  Open 
house  was  held  February 
16th  and  the  date  set  for 
initial  practice  of  a new 
physician  was  March  1st. 

* * * 

Dr.  Edwards  Peters  will 
join  the  staff  of  the  Donahoe 
Clinic  in  Sioux  Falls  in  Aug. 
Dr.  Peters  was  graduated 
from  Augustana  College  and 
is  a native  of  South  Dakota. 


NURSES  ARRANGE 
REFRESHER  WORKSHOP 

Sioux  Valley  Hospital, 
Sioux  Falls,  South  Dakota, 
is  announcing  the  third  work- 
shop for  registered  nurses  on 
new  techniques,  equipment 
and  routine  hospital  pro- 
cedures. Lectures  and 
demonstrations  will  be  pre- 
sented by  members  of  the 
medical  staff,  supervisors  of 
specialized  areas  and  other 
hospital  personnel. 

The  Refresher  Workshop 
will  be  held  April  14-18,  1958 
and  the  following  week  there 
will  be  planned  clinical  ex- 
perience available  for  those 
desiring  it. 

Registration  will  be  Mon- 
day, April  14  at  8:30  a.m.  in 
the  School  of  Nursing.  The 
tuition  fee  is  $10.00. 


Please  direct  interested 
nurses  to  write  to  the  Regis- 
trar, Department  642,  Sioux 
Valley  Hospital,  or  telephone 
4-4911,  Extension  230,  before 
April  4,  1958. 


REHAB  SESSIONS 
SCHEDULED 

The  36th  annual  scientific 
and  clinical  session  of  the 
American  Congress  by  Phys- 
ical Medicine  and  Rehabilita- 
tion will  be  held  August  24- 
29,  1958  inclusive,  at  The 
Bellevue  Stratford  Hotel, 
Philadelphia. 

Scientific  and  clinical  ses- 
sions will  be  given  August 
25,  26,  27,  28,  and  29.  All 
sessions  will  be  open  to  mem- 
bers of  the  medical  profes- 
sion in  good  standing  with 
the  American  Medical  Asso- 
ciation. 

Full  information  may  be 
obtained  by  writing  to  the 
Executive  Secretary,  Doro- 
thea C.  Augustin,  American 
Congress  of  Physical  Med- 
icine and  Rehabilitation,  30 
North  Michigan  Avenue, 
Chicago  2,  Illinois. 


PLAN  TO 
ATTEND  YOUR 
ANNUAL  MEETING 
Marvin  Hughitt  Hof'el 
Huron,  S.  Dak. 
May  17-20 


— no  — 


MARCH  1958 


ACEUTICAL 

SECTION 


HAROLD  S.  BAILEY.  PH.D. 
EDITOR 

Division  of  Pharmacy 
South  Dakota  State  College 
Brookings,  South  Dakota 


_ 111 


TRAINING  OF  PHARMACISTS  THROUGH 
THE  PRACTICAL  EXPERIENCE 
APPROACH* 
by 

Bliss  C.  Wilson** 

Pierre,  South  Dakota 


At  the  time  I was  licensed  as  a pharmacist, 
the  qualifications  for  admission  to  licentiate 
examinations  did  not  include  any  formal  edu- 
cation within  a school  or  college  of  pharmacy. 
Any  person  who  could  submit  evidence  that 
he  had  been  employed  in  a drug  store  for 
three  or  more  years  could  take  the  examina- 
tions and  if  he  received  an  average  grade  of 
seventy-five  per  cent,  or  more,  he  was  entitled 
to  a certificate  as  a licentiate  in  pharmacy. 
We  who  had  attended  a college  of  pharmacy 
were  entitled  to  credit  for  two  of  the  required 
three  years  of  practical  experience.  The  re- 
maining one  year  of  practical  experience  is 
still  a prerequisite  for  licensure  under  state 
pharmacy  laws.  The  importance  of  training 
by  experience  will  be  discussed  later. 

The  examinations  we  took  in  those  days 
were  the  same  as  the  examinations  taken  by 
the  simple  apprentice  and  the  “plugger 
school”  applicants.  It  is  interesting  to  note 
that  most  of  the  non-college  applicants  failed 
to  receive  a passing  grade  until  after  the 
third,  fourth,  and  even  after  their  sixth  trial 
while  those  with  a good  college  background 
seldom  failed  on  their  first  trial.  These  rec- 
ords indicated  the  need  for  pharmacy  college 

*Presented  at  the  Fifth  District  American  Asso- 
ciation of  Colleges  of  Pharmacy  — National  As- 
sociation of  Boards  of  Pharmacy  Meeting, 
Omaha,  October  28,  1957. 

**  Secretary,  South  Dakota  Board  of  Pharmacy. 


education  which  became  mandatory  in  our 
state  after  the  1931  legislative  session.  Pro- 
gress in  South  Dakota  was  from  “no  college 
requirement”  to  “the  four-year  college 
course,”  all  is  one  legislative  action.  You 
know  that  all  states  and  territories  now  re- 
quire not  less  than  the  B.S.  degree  for  admis- 
sion to  licentiate  examinations.  Pharmacy’s 
professional  prestige  will  be  increased,  only 
and  in  the  same  proportion,  as  pharmacy  col- 
lege educational  requirements  are  increased. 
Those  who  now  oppose  lengthening  of  the 
pharmacy  college  course,  will,  in  the  near 
future,  be  reluctant  to  give  up  the  added  pres- 
tige which  all  pharmacists  will  have  as  a re- 
sult of  such  action. 

A thorough  knowledge  of  drugs,  — their 
action  and  uses,  — their  potentially  harmful 
effects  when  taken  accidentally  or  when  used 
improperly  by  those  who  practice  self-med- 
ication, is,  in  my  opinion  of  first  importance 
in  the  education  of  a pharmacist.  It  is  only 
because  the  pharmacist  knows  these  things 
that  he  is  qualified  to  be  of  assistance  in  pro- 
tecting the  health  and  safety  of  those  who  do 
not  possess  such  knowledge.  I say,  that  it  is 
the  responsibility  of  the  colleges  of  pharmacy 
to  give  to  their  students  as  thorough  a knowl- 
edge of  existing  drugs  as  is  possible,  and  to 
teach  their  students  how  they  may  become 
thoroughly  familiar  with  new  drugs  as  they 


— 112-- 


MARCH  1958 


come  upon  the  market.  The  acquirement  of 
the  knowledge  of  drugs  must  be  a continuing 
process  throughout  the  pharmacist’s  active 
career. 

A formal  pharmacy  college  education  is 
our  foundation,  but,  it  is  not  the  attainment 
of  knowledge  alone  that  makes  pharmacy  a 
profession.  Unless  we  learn  to  apply  our 
knowledge  in  the  performances  of  profes- 
sional services,  we  have  not  done  anything  to 
warrant  a professional  standing.  The  expert 
in  any  field  of  endeavor  learns  to  do  well  by 
trial  and  error.  It  is  only  after  self-analysis 
and  re-trial  with  lesser  error  that  perfection 
can  be  reached.  The  application  of  the  ac- 
quired knowledge  of  drugs  in  the  actual  per- 
formance of  professional  pharmacy  services, 
and  improvement  in  such  pharmacy  services 
by  trial  and  error  — and  by  re-trial  with 
lesser  error,  is  my  understanding  of  exper- 
ience in  the  practice  of  pharmacy.  You  can’t 
get  it  in  college.  The  only  place  where  we 
can  learn  by  experience  is  the  place  where 
the  profession  is  actually  being  practiced. 

Now  we  come  to  the  topic  of  discussion  — 
“Should  the  Colleges  Undertake  a Program 
of  Supervising  Practical  Experience?”  I do 
not  think  that  they  should.  I do  not  think 
that  it  was  the  intent  of  the  state  legislature 
bodies  to  have  the  colleges  have  anything  to 
do  with  the  practical  experience  aspect  of 
pharmacist  training.  The  South  Dakota  Phar- 
macy law  provides  that  a candidate  for  licen- 
sure shall  have  acquired  “at  least  one  year’s 
experience  — in  the  practice  of  pharmacy 
under  a regularly  licensed  pharmacist  in  a 
pharmacy  where  physicians’  prescriptions  are 
compounded.”  It  is  clear  that  responsibility 
for  supervision  is  with  the  practitioner  and  in 
the  same  manner  that  it  was  before  any  for- 
mal pharmacy  college  education  was  required 
by  law.  When  a professional  pharmacy  ser- 
vice is  performed  by  one  who  is  not  qualified 
by  law  to  perform  that  service  and  an  error 
is  observed  or  a different  approach  to  the 
situation  would  be  more  professional,  it  is  the 
responsibility  of  the  supervisor  to  call  atten- 
tion to  such  error  or  method  of  approach.  An 
alert  apprentice  will  invite  criticism  by  his 
supervisor  so  that  he  may  learn  to  do  better. 


Self-analysis  of  error  will  gradually  be  ac- 
quired. Until  a candidate  is  able  to  analyze 
his  own  mistakes,  he  is  not  safe  to  be  trusted 
to  serve  the  public  in  a health  profession.  Let 
us  bear  in  mind,  that  the  sole  object,  the  only 
purpose  for  which  our  pharmacy  laws  were 
enacted  is  the  protection  of  public  health  and 
safety.  Pharmacists  have  the  knowledge  — 
but  until  they  learn  to  apply  it  through  ex- 
perience — the  profession  has  failed  in  its  ob- 
jective. 

If  you  have  read  the  article  in  the  October 
American  Pharmaceutical  Association  Jour- 
nal under  the  title  “Pharmacy  Internship 
Training”  you  will  recall  the  proposal  that 
certain  pharmacists  and  certain  pharmacies 
be  designated  where  candidates  must  acquire 
practical  experience.  If  the  candidate  accepts 
employment  in  any  other  pharmacy  — it 
just  doesn’t  count.  It  isn’t  the  busiest  phar- 
macy that  always  offers  the  best  place  for 
acquiring  experience;  neither  is  it  the  phar- 
macy that  fills  the  most  “count  and  pour” 
prescriptions.  The  best  place  to  acquire  ex- 
perience is  the  pharmacy  where  the  super- 
visor has  — and  will  take  time  — to  observe 
the  performance  of  professional  services  and 
to  correct  errors  which  will  lead  to  better 
practices.  Any  proposal  which  would  dictate 
minimum  volume  of  business  or  prescriptions 
filled  or  which  would  deprive  any  pharmacist 
of  his  right  to  supervise  is  unfair  and  not 
equal  justice  under  the  law.  Let  the  candidate 
make  his  own  choice  of  employer  and  super- 
visor. If  his  choice  is  unwise  — the  results 
will  be  reflected  in  grades  received  in  final 
licentiate  examinations. 

I appreciate  the  willingness  on  the  part  of 
certain  colleges  to  make  suggestions  with  re- 
gard to  improvement  of  the  practical  exper- 
ience phase  of  pharmacist  training.  Everyone 
knows  that  it  is  far  from  perfect.  But  under- 
taking a program  where  colleges  would  have 
the  responsibility  of  supervising  the  super- 
visors. No!  In  my  opinion,  the  colleges  have 
completed  their  responsibility  for  pharma- 
ceutical education  after  they  have  granted 
the  degree  in  pharmacy  which  is  a prere- 
quisite for  admission  to  licentiate  examina- 
tions. 


— 113  — 


ANIMAL  HEALTH  PHARMACY* 
Part  VII 

Kenneth  Redman,  Ph.D.** 
Contact  Insecticides 


Contact  insecticides  may  be  used  against  all 
kinds  of  insects,  but  their  use  is  particularly 
indicated  against  the  non-chewing  insects, 
i.e.,  the  piercing-sucking,  sponge-sucking,  and 
flying  insects  regardless  of  the  type  of  mouth 
parts,  and  those  insects  in  a stage  of  the  life 
cycle  in  which  they  are  not  feeding  at  all. 
Many  of  the  contact  insecticides  retain  their 
effectiveness  for  a relatively  short  time  so 
that  they  should  be  applied  thoroughly  to  kill 
all  the  insects  intended  to  be  killed  at  the 
time  of  application.  An  exception  to  this  is 
the  residual  application  of  D.D.T.  to  porches, 
dairy  barns,  etc.,  where  insects  coming  in 
contact  with  the  residue  may  be  killed  for  a 
month  or  two  after  application.  Contact  in- 
secticides are  commonly  applied  as  sprays, 
dusts,  and  aerosols. 

Much  needs  to  be  learned  as  to  how  contact 
insecticides  act.  Some,  such  as  soap  sprays, 
mechanically  obstruct  breathing,  while  others 
may  act  in  a variety  of  ways  systemically  on 
insects,  as  in  warm  blooded  animals.  Nicotine 
in  some  way  acts  on  nerve  ganglia,  pyrethrin 
blocks  nerve  impulses  on  motor  nerves,  ro- 
tenone  in  some  manner  paralyzes  the  circula- 
tion and  respiration,  oils  may  kill  by  a com- 
bination of  actions,  the  dinitrophenols  may 
act  by  greatly  increasing  the  metabolic  rate 

*The  seventh  of  a series  of  articles  concerning  the 
role  of  the  pharmacist  in  animal  and  plant 
health. 

**  Professor  and  Head  of  the  Department  of  Phar- 
macognosy, Division  of  Pharmacy,  South  Dakota 
State  College. 


and  the  need  for  oxygen,  D.D.T.  stimulates 
sensory  nerve  ends  which  produces  tremors, 
and  the  organic  phosphates  poison  cholin- 
esterase, the  acetylcholine  then  allowed  to 
accumulate  causes  uncoordinated  muscle  ac- 
tivity. Insecticides  can  only  be  used  to  their 
best  advantage  as  more  pharmacology,  toxi- 
cology, and  physiology  of  insects  is  learned. 

Contact  Insecticides  from  Plants  and  their 
Analogues 

Tobacco  has  been  used  as  an  insecticide 
since  early  colonial  times.  It  varies  so  much 
in  its  nicotine  and  other  insecticidal  alkaloidal 
constituents,  however,  that  it  is  advisable  to 
use  manufacturers’  standardized  products, 
rather  than  the  crude  product  as  grown  by 
the  farmer.  Nicotine,  a volatile  alkaloid,  is 
characterized  by  being  insoluble  in  water  but 
forming  water  soluble  non-volatile  salts  with 
acids.  Nicotine  is  one  of  the  most  deadly  of 
substances,  killing  insects  and  other  animals 
either  by  inhalation  of  the  vapor,  absorption 
by  external  contact,  or  through  the  alimen- 
tary tract.  Nicotine  is  commonly  marketed 
in  the  United  States  in  the  form  of  the  sul- 
fate. Not  more  than  40  per  cent  concentrates 
are  to  be  found  in  the  retail  trade  because  of 
the  greater  danger  of  higher  concentrations 
to  the  user.  Tobacco  concentrates  or  nicotine 
prepartions  are  commonly  used  in  the  form 
of  sprays  and  dusts,  both  of  which  can  be 
regulated  to  release  volatile  nicotine  in  a 
short  period  of  time  (0-4  hours)  or  for  a long 
period  of  several  days.  In  sprays,  an  alkali 


— 114  — 


MARCH  1 958 


such  as  soap  is  used  to  neutralize  the  acid  in 
the  nicotine  sulfate  to  give  a quick  release  of 
the  nicotine  and  to  act  as  a spreader,  while  in 
dusts  hydrated  lime  is  commonly  used,  al- 
though the  alkali  carbonates  will  give  a 
quicker  release  of  the  nicotine.  Sprays  com- 
monly have  about  0.5  per  cent  actual  nicotine 
and  dusts  vary  from  1 to  4 per  cent.  Prepared 
dusts  are  not  stable  for  long  periods  of  time 
even  in  tight  containers,  so  that  such  prep- 
arations should  carry  an  expiration  date. 
Nicotine  insecticides  are  recommended 
against  insects  with  small  soft  bodies,  such  as 
aphids  and  thrips,  for  quick  action  on  flowers 
to  prevent  staining.  Nicotine  sulfate  is  very 
extensively  used  for  the  small,  soft  bodied 
sucking  insects  on  plants,  and  for  poultry  lice. 

Rotenone  is  commonly  used  either  in  dusts 
or  sprays  or  in  the  form  of  derris  and  cube 
roots,  its  chief  commercial  sources.  Since 
derris  grows  in  the  Far  East  mainly,  and  the 
spcies  of  Lonchocarpus  producing  cube 
root  grow  in  South  America,  rotenone  has 
been  a scarce  insecticide  in  the  United  States 
during  war  times  when  transportation  is 
always  a problem.  Rotenone  has  not  been 
found  in  commercial  quantities  in  plants 
growing  in  the  United  States.  Rotenone  has 
been  used  as  an  insecticide  with  the  idea  that 
its  residue  is  relatively  harmless  to  warm 
blooded  animals;  however  it  does  irritate  the 
human  skin  and  internally  moderate  amounts 
are  very  toxic  to  the  higher  animals.  Since 
rotenone  is  not  stable  to  light,  the  small  resi- 
dues left  on  plants  after  application  as  an  in- 
secticide and  the  probable  decomposition 
within  a short  time  are  factors  favorable  to 
its  safe  use.  Rotenone  is  a fairly  rapid  acting 
and  certain  insecticide  and  is  applied  in  the 
form  of  dusts,  sprays,  baits,  aerosols,  and  dips. 
Aqueous  sprays  must  be  freshly  prepared 
since  they  decompose  rapidly.  Some  of  the 
more  common  insects  controlled  by  rotenone 
include  those  on  food  crops  (Mexican  bean 
beetle,  cabbage  worms,  leaf  hoppers,  etc.), 
cattle  grubs  and  lice,  and  fleas  and  ticks  on 
pets  and  domestic  animals.  Until  recently 
it  has  been  claimed  to  be  the  only  known 
effective  control  for  cattle  grubs  (2V2  per  cent 
dust).  Rotenone  may  be  used  with  neutral  or 
inert  dust  diluents  (0.5-1  per  cent).  It  should 
not  be  combined  with  lime-sulfur  solutions  or 
with  Bordeaux  mixture. 


Pyrethrum  Flowers,  N.  F.,  has  been  used 
as  an  insecticide  for  over  150  years.  Chrys- 
anthemum cinerariaefolium  (Family  Com- 
positae),  now  the  chief  commercial  source,  is 
produced  extensively  in  Japan  and  Kenya; 
less  extensively  in  the  U.  S.  and  Dalmatia.  The 
chief  constituents  are  commonly  referred  to 
as  pyrethrin  I and  pyrethrin  II,  but  these  are 
now  known  to  be  mixtures  with  cinerin  I and 
cinerin  II,  respectively.  The  National  Form- 
ulary requires  a yield  of  not  less  than  0.5  per 
cent  of  total  pyrethrins  (Pyrethin  I and  Pyre- 
thin  II).  Pyrethrum  Flowers  are  now  mostly 
extracted  with  organic  solvents  to  form  con- 
centrates of  about  20  per  cent  pyrethrins.  The 
concentrates  are  then  used  to  make  dusts, 
sprays,  aerosols,  emulsion  concentrates,  etc. 
The  pyrethrins  are  extensively  used  for  their 
“knock-down”  effect  on  flying  insects,  espec- 
ially. Often  slower  acting  insecticides,  i.e., 
D.D.T.,  are  incorporated  into  a pyrethrin 
formula  to  complete  the  job  of  killing  insects. 
Another  aspect  of  the  pyrethrins  is  the  syner- 
gistic effect  obtained  by  not  only  other  insec- 
ticides but  by  other  agents  also,  i.e.,  sesamin, 
sulfoxide,  etc. 

Since  the  pyrethrins  are  very  unstable  in 
light,  especially,  as  well  as  in  moisture  and 
air,  they  enjoy  a continued  popularity  for 
household  use  and  against  flies  on  dairy  cattle 
where  lack  of  stability  is  not  an  important 
factor,  but  where  quick  action  is.  They  are 
used  to  some  extent  in  the  forms  of  sprays, 
dusts,  and  aersols  against  garden  and  yard 
insects.  Pyrethum  Flowers  are  reported  to 
have  some  value  as  an  insect  repellent  and 
since  the  pyrethins  are  recognized  as  the  ac- 
tive constituents,  it  follows  that  they  are  re- 
pellents also.  This  is  an  advantage  in  sprays 
for  dairy  cattle,  particularly. 

Allethrin,  a viscous  liquid,  insoluble  in 
water  but  soluble  in  the  liquid  petroleum  hy- 
drocarbons, contains  75-98  per  cent  CinH^eO-s 
as  commercially  produced.  Allethrin  was 
produced  during  the  long  tedious  study  of  the 
chemical  structure  of  the  pyrethrins.  Its  in- 
dications and  uses  are  similar  to  the  pyre- 
thrins, particularly  in  aerosols  as  house 
sprays.  Allethrin  is  cheaper  to  produce  than 
the  pyrethrins,  but  this  advantage  is  at  least 
partially  offset  by  the  lack  of  the  extensive 
synergistic  effect  of  the  pyrethrins  with  other 
compounds.  One  possible  advantage  during 
war  time  is  the  possibility  of  producing  alle- 


— 115  — 


SOUTH  DAKOTA 


thrin  when  there  is  a scarcity  of  Pyrethrum 
Flowers  and  the  pyrethrins.  Allethrin  is  an 
efficient  insecticide  for  the  pediculi  of  hu- 
mans. 

Sabadilla,  the  seed  of  various  species  of 
Schoenocaulon.  has  been  used  as  an  insecti- 
cide for  centuries.  A mixture  of  the  alkaloids 
is  known  as  veratrine,  an  unfortunate  nomen- 
clature, since  it  suggests  an  alkaloid  from 
Veratrum  species.  Heating  the  seed  to  150°C 
for  1 hour,  mixing  the  powdered  seed  with  an 
alkali  such  as  hydrated  lime,  and  aging  are 
factors  in  increasing  the  effectiveness  of  the 
crude  product  or  its  extracts.  Veratrine  oxi- 
dizes readily  on  exposure  to  light  and  air,  so 
that  there  is  not  much  danger  of  toxic  resi- 
dues being  left  on  agricultural  products  for 
consumption  by  livestock  and  humans.  There 
is  little  danger  of  injury  to  plants,  too.  Saba- 
dilla and  veratrine  are  irritating  to  the  skin 
and  mucous  membranes  of  warm  blooded  an- 
imals, requiring  proper  precautions  in  handl- 
ing them,  including  the  use  of  a respirator. 
Powdered  sabadilla  seed  1 part  with  10  parts 
of  wettable  sulfur  is  claimed  to  be  effective 
against  cattle  lice.  A commercial  sabadilla 
preparation  with  sugar  is  used  against  citrus 
thrips. 

Oil  Sprays  As  Contact  Insecticides 

Oil  sprays,  another  group  of  the  contact 
insecticides,  were  used  to  a limited  extent  as 
early  as  1763.  They  were  well  recognized 
early  in  the  19th  century,  but  since  the  oils 
were  used  unmodified,  their  phytotoxicity 
limited  their  usefulness.  By  the  eighteen 
fifties,  the  commercial  production  of  petro- 
leum added  it  and  kerosene  to  the  earlier  oil 
sprays,  such  as  turpentine  oil,  with  phyto- 
toxicity still  a major  problem.  By  1870  the 
first  satisfactory  oil  sprays  for  plants  were 
prepared  by  emulsifying  the  oils  with  water. 
The  oil  sprays  were  well  established  by  1875, 
using  good  kerosene,  soap,  and  water  emul- 
sions. About  1920,  lubricating  oil  emulsion 
sprays  were  effectively  used  against  the  San 
Jose  scale.  By  1930  highly  refined  white  oils 
from  petroleum,  relatively  free  from  un- 
saturated hydrocarbons  and  highly  volatile 
fractions,  were  established  as  safe  sprays  on 
leaves.  Some  of  the  more  important  uses  of 
oils  sprays  and  the  types  indicated  include: 
(1)  dormant  (winter)  sprays  for  scale  insects, 
insect  eggs  (ovicide),  and  mites;  (2)  summer 
(foliage)  sprays  for  aphids,  scale  insects,  and 


mealy  bugs;  (3)  parasiticides  for  lice,  mites, 
and  fleas  on  domestic  animals  and  certain 
pets;  (4)  carriers  for  other  insecticides,  i.e., 
pyrethrum,  D.D.T.,  thiocyanates,  sulfur, 
nicotine,  rotenone,  etc. 

The  kinds  of  oils  used  in  oil  sprays  include: 
(1)  fixed  oils  of  plant  and  animal  origin,  i.e., 
fish,  soy,  castor,  and  linseed  oils  for  making 
soaps  for  insecticidal  use;  (2)  volatile  oils  and 
related  substances,  i.e.,  methyl  salicylate, 
anise,  citronella,  peppermint  and  camphor, 
for  use  as  attractants  in  baits  mostly,  but 
sometimes  as  repellents;  (3)  petroleum  oils  in 
a large  variety  of  grades  designed  for  many 
uses  from  dormant  to  foilage  sprays.  Vola- 
tility, viscosity,  the  amount  of  saturated  and 
unsaturated  hydrocarbons,  surface  tension, 
and  the  amount  of  unsulfonated  residue  are 
some  of  the  important  factors  governing  the 
uses  of  the  petroleum  oils.  In  general,  the 
lower  the  volatility  the  more  insecticidal  the 
petroleum  oil,  until  a limit  is  reached  when 
the  oil  is  not  volatile  enough  to  penetrate  the 
tracheal  system  of  the  insect.  Lighter  oils  are 
more  toxic  to  plants.  The  problem  is  to  find 
the  heaviest  oil  that  will  kill  the  insects  on  a 
host  plant  which  is  light  enough  to  be  used 
with  safety  on  it.  In  general,  the  lower  the 
viscosity  of  the  oils,  the  safer  they  are  to  use 
on  plants.  Too  much  volatile  hydrocarbons  as 
impurities  in  dormant  sprays  is  not  desirable. 
An  oil  with  a low  surface  tension  has  a 
greater  wetting  and  spreading  ability;  hence 
covers  foliage  and  insect  surfaces  more  ef- 
ficiently. The  unsulfonated  residues  in  pe- 
troleum oils  brings  about  a slow  oxidation  of 
the  oil  film,  producing  organic  acids  harmful 
to  plants.  Climatic  conditions  are  other  fac- 
tors to  be  considered  in  the  application  of  oil 
sprays.  Dry  soil  or  drying  winds  and  freez- 
ing temperatures,  for  instance,  are  more 
likely  to  cause  the  dormant  sprays  to  damage 
plants. 

Sulfur  and  Sulfur  Compounds  as  Contact 
Insecticides 

Lime-sulfur  sprays  have  been  used  as  a 
contact  insecticide  for  many  years.  They  are 
still  extensively  used  for  both  their  insecti- 
cidal and  fungicidal  actions.  Reacting  slaked 
lime  [Ca(OH)2]  with  sulfur  is  the  most  com- 
mon method  of  getting  the  sulfur  into  solu- 
tion, but  potassium,  sodium,  ammonium, 
barium  and  magnesium  hydroxides  could  be 
used.  In  the  reaction  just  mentioned,  various 


— 116  — 


MARCH  1958 


polysulfides  of  calcium  are  formed,  calcium 
pentasulfide  (CaSr.)  being  reported  as  the 
most  effective  one  as  an  insecticide  and  fun- 
gicide. Since  calcium  pentasulfide  is  lost  by 
prolonged  boiling  of  the  reaction  mixture,  it 
is  best  to  not  continue  boiling  for  more  than 
45  to  60  minutes.  Calcium  sulfite  may  be 
formed  in  the  reaction  and  since  it  is  rela- 
tively insoluble  in  water,  it,  together  with 
any  excess  lime  or  sulfur  will  settle  out  as  a 
sludge  and  should  be  separated  by  siphoning 
or  decantation.  A recommended  formula  for 
a lime-sulfur  solution  is  hydrated  lime  67 
lbs.,  powdered  sulfur,  100  lbs.,  water,  q.s.  100 
cong.  Agitate  while  boiling  for  about  50 
minutes.  A good  lime-sulfur  solution  has  a 
specific  gravity  of  31-33°  Baume.  This  should 
be  diluted  according  to  specific  directions  be- 
fore use  as  a spray.  Lime-sulfur  sprays  (2  per 
cent)  are  used  against  the  brown  rot  in  peach 
orchards,  various  diseases  and  pests  of  almond 
and  prume  orchards  and  citrus  groves, 
powdery  mildew  of  apple  orchards  (2.5-3  per 
cent)  and  certain  scale  insects,  including  the 
San  Jose  scale.  There  is  some  danger  of  lime- 
sulfur  sprays  damaging  foliage,  especially  if 
they  are  applied  when  the  atmospheric  tem- 
perature is  about  90°F.  or  above.  Special 
formula  lime-sulfur  solutions  are  used  as 
sheep  and  cattle  dips  for  scab  mites,  etc. 

A somewhat  less  effective  form  of  lime- 
sulfur  is  prepared  in  dry  form  to  be  mixed 
with  water  just  prior  to  use.  The  advantages 
claimed  is  that  (1)  it  eliminates  much  of  the 
bother  of  preparation  by  the  user  and  (2)  the 
shipment  of  water,  if  the  liquid  preparation 
is  used  at  a distance  from  the  place  of  manu- 
facture. Lime-sulfur  sprays  are  sometimes 
combined  with  nicotine  sulfate,  oil  emulsions, 
or  petroleum  oils.  Lime-sulfur  sprays  should 
not  be  combined  with  Bordeaux  mixture, 
pyrethrin,  or  rotenone,  because  of  the  alka- 
linity of  the  lime-sulfur  solution. 

Elemental  sulfur  is  another  contact  insec- 
ticide which  exists  in  a variety  of  commer- 
cial forms:  (1)  wettable  sulfur,  (2)  flotation 
sulfur,  (3)  colloidal  sulfur,  (4)  sublimed  sul- 
fur, (5)  ground  sulfur,  and  (6)  micronized  sul- 
fur. These  various  forms  of  sulfur  result  from 
different  methods  of  manufacture,  of  course, 
some  being  amorphous  and  others  crystalline. 
At  present,  sulfur  is  used  more  as  a fungicide 
than  as  an  insecticide,  but  in  both  instances, 
within  limits  (25-2  microns),  particle  size  is 


inversely  proportional  to  activity.  Sulfur  par- 
ticles larger  than  about  25  microns  have  been 
shown  to  be  essentially  valueless  as  insecti- 
cides and  fungicides,  but  particles  smaller 
than  about  2 microns  drift  too  badly  to  be 
satisfactorily  used  as  dusts.  The  fine  sulfurs 
may  be  prepared  as  pastes,  however,  to  be 
used  in  sprays  to  advantage.  Sulfur  acts  as  a 
fungicide  and  insecticide  by  sublimation  after 
application.  Since  the  sublimation  is  only 
effective  at  close  proximity  (about  1 micron) 
to  fungus  spores  or  insects,  the  host  must  be 
uniformity  well  covered  with  sulfur  for  max- 
imum results.  Applied  in  atmospheric  tem- 
peratures above  85 °F.,  the  sublimation  may 
be  sufficiently  rapid  to  harm  plants.  Sulfur 
is  sometimes  diluted  with  10  to  50  per  cent 
of  inert  material  to  lessen  the  danger  of 
“burning”  plants.  Diluents  are  also  added  as 
“conditioners”  to  keep  some  of  the  finer  sul- 
furs from  caking  and  also  to  make  the  sulfur 
more  easily  wetted,  since  particles  of  sulfur 
become  electrically  charged  very  easily  and 
cannot  be  wetted  in  such  a condition.  Ground 
sulfur  in  various  grades  is  the  form  most  gen- 
erally used  as  a pesticide  in  the  United  States. 
It  commonly  is  referred  to  as  325-mesh  sul- 
fur and  is  prepared  with  specific  conditioners 
for  both  sprays  and  dusts.  Sulfur  has  had  a 
reputation  as  a miticide,  but  it  is  most  fre- 
quently used  now  as  an  insecticide  in  com- 
bination with  other  insecticides,  such  as  DDT, 
not  only  as  a miticide  but  also  against  cotton 
insects  and  others. 

Organic  thiocyanates  have  been  used  as 
contact  insecticides  since  1932,  acting  on  the 
nervous  system  of  insects  — possibly  as  res- 
piratory and  circulatory  paralyzants.  They 
have  a rapid  action  and,  hence,  give  a good 
knockdown  of  flying  insects.  Since  they  will 
not  stain  or  corrode  household  furnishings 
under  ordinary  use,  and,  since  they  are  not 
very  toxic  to  mammals,  they  are  indicated  for 
use  in  household  insecticides  and  in  cattle 
sprays.  Some  of  the  more  commonly  used 
organic  thiocyanates  include:  Isobornyl  thio- 
cyanoacetate  (Thanite),  beta-butoxy-beta-thio- 
cyanodiethylether  (Lethane  384),  beta-thio- 
cyanoethyl  laurate  (Lethane  60),  and  lauryl 
thiocyanate  (Loro).  Lethane  384  and  Loro  are 
also  used  for  the  control  of  leafhoppers,  thrips, 
white  flies,  aphids,  and  mealy  bugs  on  green- 

(Continued  on  Page  121) 


— 117  — 


aceuticaO 


THE  PRESCRIPTION  PHARMACIST 
TODAY* 


Part  11 
by 

Wallace  Croalman  and  Paul  B.  Sheatsley 
New  York  City,  New  York 
The  Stores  They  Work  In 


Prescriptions  are  by  far  the  leading  source 
of  business  in  the  stores  where  the  survey 
was  made.  Among  the  druggists  interviewed, 
15  per  cent  indicate  that  prescriptions  account 
for  two-thirds  or  more  of  the  store’s  total 
business,  while  another  24  per  cent  say  that 
prescriptions  account  for  about  half  the 
store’s  business.  (This  survey,  of  course,  was 
weighed  in  favor  of  stores  doing  a large 
volume  of  prescription  business.) 

Next  to  prescriptions,  proprietary  and  pa- 
tent medicines  are  the  main  source  of  rev- 
enue in  the  stores  studied.  Then  come  cos- 
metics, toiletries,  baby  needs,  and  similar 
products.  Although  about  three  out  of  five 
stores  have  soda  fountains,  food  and  soft 
drinks  are  a relatively  minor  source  of  in- 
come — at  least  in  the  stores  surveyed. 

The  great  majority  of  stores  — 87  per  cent 
— are  classified  as  independent  by  the  phar- 
macists surveyed,  while  10  per  cent  are  mem- 
bers of  large  chains  and  3 per  cent  are  mem- 
bers of  small  chains.  As  far  as  total  volume 
of  business  is  concerned,  44  per  cent  of  the 
respondents  estimate  gross  sales  for  the  pre- 
vious twelve  months  at  $100,000  or  more;  32 

* This  is  the  second  of  a series  of  articles  present- 
ing a factual  study  of  the  pharmacists  role  in  the 
health  field.  The  study  was  made  possible  by  a 
grant  from  the  Health  Information  Foundation. 
The  first  article  will  be  found  in  Volume  II,  No. 
1,  January  1958. 


per  cent  put  the  figure  at  between  $50,000 
and  $100,000,  and  17  per  cent  put  it  at  under 
$50,000. 

The  pharmacists  seem  well  satisfied  with 
the  stores  they’re  connected  with.  Against 
the  85  per  cent  who  say  that  the  stores  are  in 
good  locations,  only  3 per  cent  say  they’re 
poorly  located.  Yet  many  stores  are  in  areas 
where  competition  is  severe:  More  than  half 
the  stores  surveyed  are  in  areas  that  have 
three  or  more  drug  stores.  Only  one  store  in 
six  has  no  competition  in  its  area. 

How  They  Like  Their  Work 

The  pharmacists  in  this  study  shape  up  as 
a reasonably  well  adjusted,  satisfied  group  — 
and  a group  with  few  delusions  of  grandeur 
about  their  place  in  the  health  field. 

Opinion  is  fairly  evenly  divided  about 
whether  the  general  public  regards  the  phar- 
macist mainly  as  a professional  man  or 
mainly  as  a businessman.  Against  the  48  per 
cent  of  the  pharmacists  answering  “mainly 
professional,”  44  per  cent  say  “mainly  bus- 
iness.” (The  remainder  won’t  venture  a 
guess.)  Among  druggists  who  think  the  pub- 
lic regards  them  as  primarily  businessmen, 
interestingly  enough,  there  is  a fairly  strong 
feeling  that  they  would  prefer  to  be  consid- 
ered professional  men. 

Does  pharmacy  require  more  professional 
ability  today  than  ten  or  fifteen  years  ago,  or 


— 118  — 


MARCH  1 958 


less  ability?  Sixty  per  cent  of  the  druggists 
say  “more”ability  today,  while  only  22  per 
cent  say  “less.”  These  major  reasons  are  cited 
by  the  majority: 

“The  new  drugs  are  more  complex,  tech- 
nical, powerful;  the  pharmacist  needs  more 
skill  and  training  in  order  to  understand  and 
handle  them.” 

“There  are  more  drugs  to  know  about,  and 
new  ones  keep  coming  out  all  the  time.  It’s 
harder  to  keep  up  with  the  field,  and  so  the 
pharmacist  needs  more  skill  and  training. 

“More  knowledge  is  needed  today  in  deal- 
ing with  the  public.  People  are  better  edu- 
cated, more  sophisticated  about  drugs,  and 
expect  more  of  the  pharmacist.” 

“Doctofs  rely  more  on  the  pharmacist  today 
for  information  and  advice  about  drugs.” 

Less  than  1 per  cent  of  all  pharmacists  cite 
today’s  greater  legal  regulations  and  restric- 
tions as  a reason  why  pharmacists  need  more 
ability  these  days. 

Among  the  relatively  few  pharmacists  who 
feel  that  less  ability  is  needed  today,  this  one 
comment  is  typical:  “Medicines  are  ready- 
made, pre-packaged  today.  Hardly  any  com- 
pounding is  required.  The  pharmacist  just 
orders  what  he  needs,  counts  out  pills,  pours 
from  one  bottle  to  another.” 

Although  most  of  the  men  concede  that 
there  are  problems  in  their  work,  52  per  cent 
nevertheless  consider  pharmacy  a “very 
good”  field  for  a young  man  to  enter.  Another 
37  per  cent  call  it  a “fairly  good”  field  — so 
only  a very  few  druggists  are  openly  pessi- 
mistic about  the  future  of  their  profession. 
Significantly,  the  most  favorable  opinions 
come  from  young  pharmacists  themselves: 
Among  druggists  39  or  younger,  63  per  cent 
consider  theirs  a “very  good”  field. 

Despite  these  generally  favorable  impres- 
sions, two  out  of  five  druggists  point  to 
specific  shortcomings  in  their  line  of  work. 
The  leading  complaints  have  an  economic 
base:  low  pay,  not  enough  profit,  little  or  no 
chance  of  advancement,  etc.  Complaints 
about  hours  and  working  conditions  are  also 
common:  “We  work  too  long  for  what  we  get 
out  of  it;”  “You’re  on  your  feet  all  day;”  and 
similar  comments. 

Another  sore  spot  with  some  pharmacists 
is  lack  of  prestige.  A number  of  druggists  say 
that  doctors  and  the  public  fail  to  show  them 
the  respect  that  their  training,  education,  and 


responsibilities  entitle  them  to. 

On  the  other  hand,  more  than  two-thirds  of 
the  pharmacists  in  the  study  have  favorable 
comments  to  make  about  their  profession. 
Half  the  men  with  such  comments  say  that 
the  field  pays  well;  others  point  to  a sense  of 
security  in  the  field  or  comment  that  it  is 
always  easy  to  get  a job  because  there  is  a 
shortage  of  trained  pharmacists.  Factors  cited 
less  often  include  the  social  usefulness  of  the 
profession,  good  hours  and  working  con- 
ditions, and  a feeling  that  pharmacy  is  a pro- 
fession that  people  look  up  to. 

In  other  words,  while  some  druggists  com- 
plain about  low  pay,  unfavorable  working 
condition,  and  lack  of  prestige,  others  are 
favorably  impressed  by  the  same  factors  of 
income,  working  conditions,  and  prestige. 
Apparently  there  are  good  and  bad  jobs  in 
pharmacy  as  in  every  other  field  — and  ap- 
parently, too,  different  pharmacists  have  dif- 
ferent concepts  of  what  they  should  get  out 
of  their  work. 

What  major  problems  face  druggists  in 
their  relations  with  the  public?  Twenty-eight 
per  cent  of  the  men  surveyed  fail  to  identify 
any  specific  issues.  Fourteen  per  cent  cite 
problems  dealing  with  pubic  ignorance,  mis- 
understanding, and  complaints  about  prices, 
and  the  same  proportion  mention  the  need 
to  win  greater  public  respect  for  pharmacy 
as  a profession. 

What  They  Say  About  Prescriptions, 
Drug  Costs,  and  Drug  Manufacturers 

The  pharmacists  in  this  study  probably 
spend  more  time  actually  working  with  pres- 
cription drugs  than  would  a truly  random 
selection  of  the  profession.  Sixty-two  per 
cent  of  those  surveyed,  in  fact,  spend  at  least 
half  their  working  hours  dealing  with  pres- 
criptions. There  is  special  pertinence,  then, 
in  what  these  pharmacists  say  about  prescrip- 
tion costs,  customer’s  views  on  prescriptions, 
and  similar  matters. 

Four  out  of  five  druggists  get  at  least  occas- 
ional complaints  about  prescription  prices. 
But  only  9 per  cent  say  that  such  complaints 
come  up  “very  often.”  Most  druggists  who 
report  some  measure  of  customer  dissatisfac- 
tion concede  that  complaints  come  up  only 
occasionally.” 

When  customers  complain  about  prescrip- 
tions, the  issue  is  almost  always  the  price  — 
at  least,  this  is  the  way  the  pharmacist  sees 


— 119  — 


SOUTH  DAKOTA 


it.  Only  4 per  cent  of  the  men  surveyed  admit 
to  getting  complaints  very  often  or  fairly 
often  concerning  the  time  it  takes  to  fill  a 
prescription;  only  7 per  cent  say  that  patients 
complain  very  often  or  fairly  often  about 
prescriptions  calling  for  more  medicine  than 
seems  necessary. 

At  what  price  does  the  public  begin  to  com- 
plain that  a prescription  costs  too  much? 
About  19  per  cent  of  the  pharmacists  say  they 
usually  get  complaints  about  price  at  some 
figure  under  $4;  38  per  cent  name  a figure  in 
the  $4-$5.99  range;  and  14  per  cent  set  the 
figure  at  $6  or  more.  Seven  per  cent  deny 
receiving  any  complaints,  and  the  remaining 
22  per  cent  say,  in  effect,  “No  special  price. 
Some  people  will  complain  at  any  price.” 

Seventy-seven  per  cent  of  the  pharmacists 
single  out  antibiotics  as  the  medicine  most 
frequently  involved  in  price  complaints. 
Hormone  preparations  are  mentioned  by  33 
per  cent  of  all  pharmacists;  vitamin  prepara- 
tions, by  11  per  cent.  (Some  respondents 
name  more  than  one  category.)  This  doesn’t 
necessarily  mean  that  antibiotics  are  receiv- 
ing a disproportionate  number  of  complaints, 
of  course;  it  may  simply  reflect  the  frequency 
with  which  antibiotics  are  prescribed.  It’s 
worth  noting,  in  passing,  that  when  this  study 
was  made,  in  1955,  the  pubic  was  far  less 
familiar  with  the  term  “tranquilizer”  than  it 
is  now. 

The  pharmacists’  views  on  what  customers 
think  about  prescription  costs  do  not  always 
square  with  the  answers  given  by  customers 
themselves.  Here  are  a few  pertinent  find- 
ings from  the  interviews  with  the  general 
public: 

Two  out  of  every  three  persons  interviewed 
describe  the  price  of  prescriptions  as  “much 
too  high”  or  “somewhat  high.”  (About  three 
out  of  five  doctors  surveyed  agree  with  the 
public’s  view.)  Who  is  to  blame  for  high 
prices?  The  public  blames  retail  druggists 
far  more  often  than  it  blames  drug  manufac- 
turers, doctors,  or  other  interested  parties. 

More  than  half  of  the  representatives  of  the 
public  interviewed  recall  buying  one  of  the 
“miracle  drugs”  (antibiotics,  sulfa  drugs,  and 
the  like)  at  some  time  or  other.  Of  the  per- 
sons in  this  group,  48  per  cent  say  the  drug 
cost  more  than  they  expected,  6 per  cent  say 
it  cost  less,  and  38  per  cent  say  it  cost  about 
what  they  expected.  Four  out  of  every  five 


customers  were  “entirely  satisfied”  with 
their  experience  with  miracle  drugs.  Of  those 
reporting  any  dissatisfaction  with  their  pur- 
chases, fewer  than  one  in  five  complained 
about  the  cost. 

Do  customers  question  the  price  of  pre- 
scriptions more  today  than  they  did  ten  years 
ago?  Forty-one  per  cent  of  the  pharmacists 
feel  that  complaints  are  more  common  today; 
27  per  cent  think  they’re  less  common;  and 
the  remainder  fail  to  notice  any  difference. 

Pharmacists  stating  that  complaints  are 
more  common  today  attribute  the  trend  to 
two  main  factors:  the  increasing  reliance  on 
new,  necessarily  expensive  drugs;  a rise  in 
the  price  of  all  drugs,  old  as  well  as  new. 
Druggists  who  believe  that  complaints  are 
less  common  today  generally  explain  that 
times  are  more  prosperous  these  days,  and 
that  people  are  more  used  to  paying  high 
prices  for  everything. 

Two  out  of  three  pharmacists  feel  that  cus- 
tomers complaints  about  prescription  costs 
are  “hardly  ever”  justified,  and  only  one  man 
in  ten  says  they  are  “usually”  justified.  Still, 
complaints  do  come  up.  How  do  the  phar- 
macists deal  with  them? 

The  most  common  explanation  given  to 
complaining  customers,  say  the  druggists,  is 
that  research,  development,  and  production 
costs  are  necessarily  high,  and  that  these  costs 
account  for  what  seems  like  a high  price  to 
the  consumer.  Another  favorite  explanation 
is,  “The  drug  is  worth  the  cost;  it  saves  money 
in  the  long  run.”  Only  16  per  cent  of  the  phar- 
macists admit  countering  customers’  corn- 
paints  with  answers  justifying  their  own  con- 
duct. Among  this  group,  stock  replies  include, 
“I  have  to  pay  a lot  for  the  drug,”  “I  only 
make  a small  profit  on  it,”  and  other  remarks 
in  this  vein. 

On  an  even  touchier  subject,  three  out  of 
four  pharmacists  deny  that  people  ever  ask 
them  to  suggest  a less  expensive  medicine  as 
a substitute  for  a prescription  drug.  Those 
who  admit  getting  such  requests  almost  in- 
variably deny  going  along  with  the  customers 
request.  What  do  they  do,  then?  Here  are 
three  typical  replies: 

“I  tell  the  customers  it’s  illegal  and  un- 
ethical.” 

“I  defend  the  prescription  and  praise  the 
doctor.” 

“I  tell  them  to  see  the  doctor  about  it.” 


— 120  — 


MARCH  1 958 


Most  pharmacists  (84  per  cent)  say  that  doc- 
tors should  warn  patients  in  advance  when  a 
prescription  will  be  expensive,  but  only  10 
per  cent  of  all  druggists  feel  that  the  doctor 
should  actually  estimate  the  cost.  By  con- 
trast, 42  per  cent  of  all  physicians  say  they 
do  estimate  the  cost  of  an  expensive  prescrip- 
tion for  the  patient,  and  another  51  per  cent 
warn  that  a drug  will  probably  be  expensive. 
Doctors,  according  to  the  druggists  in  this 
study,  have  a fairly  good  idea  of  what  a pre- 
scription will  cost;  seven  out  of  ten  phar- 
macists say  that  prices  for  filling  prescrip- 
tions do  not  vary  much  from  one  drug  store 
to  another  in  their  area. 

On  the  subjects  of  drug  manufacturers, 
wholesalers,  and  contacts  with  these  sources, 
the  pharmacists  opinions  can  be  summed  up 
as  follows: 

The  druggists  show  a fairly  pronounced 
preference  for  detail  men  over  printed  ma- 
terial as  a means  of  learning  about  new  drugs. 
Fifty-four  per  cent  of  the  men  surveyed  list 
detail  men  as  the  preferred  source  of  infor- 
mation, while  only  29  per  cent  prefer  litera- 
ture. 

How  can  detail  men  be  more  helpful  to  re- 
tail druggists?  Suggestions  include  more  fre- 
quent visits,  distribution  of  more  literature 
to  supplement  visits,  the  detailing  of  drug- 
gists before  doctors,  and  the  practice  of  leav- 
ing samples  of  new  drugs  for  filling  initial 
prescriptions. 

When  asked  how  drug  wholesalers  might 
be  more  helpful  to  them,  more  than  half  the 
pharmacists  failed  to  specify  any  suggestions; 
only  26  per  cent  failed  to  suggest  ways  in 
which  drug  manufacturers  could  be  more 
helpful.  Three  out  of  ten  druggists,  in  men- 
tioning ways  in  which  manufacturers  could 
be  more  helpful,  said  they  should  stop  dup- 
licating each  other’s  products.  Other  sugges- 
tions for  improvement:  Detail  the  store  more; 
provide  more  information  about  new  drugs 
before  prescriptions  begin  to  come  in. 

Two  out  of  three  pharmacists  believe  vol- 
untary health  insurance  has  had  no  effect  on 
their  prescription  business  as  yet.  Most  drug- 
gists concede,  however,  that  they  would  be 
affected  if  more  health-insurance  policies 
covered  drug  costs  — and  they’re  not  at  all 
sure  that  the  effect  would  be  beneficial  to 
them. 

Some  pharmacists,  it’s  true,  feel  that  such 


coverage  would  enable  more  people  to  buy 
necessary  medicine;  but  others  argue  that 
broader  insurance  policies  would  result  in 
more  prescriptions  being  filled  in  hospitals, 
more  red  tape,  possibly  price  fixing,  and  per- 
haps more  governmental  interference  in  med- 
icine. For  these  and  other  reasons,  more  than 
half  the  pharmacists  surveyed  indicate  they 
would  oppose  having  prescription  costs  made 
part  of  prevailing  health-insurance  contracts. 


ANIMAL  HEALTH  PHARMACY— 

(Continued  from  Page  119) 
house  and  garden  plants.  Many  of  the  thio- 
cyanates are  used  in  2.5  to  5 per  cent  oil 
sprays,  but  some,  i.e..  Loro,  is  marketed  as  a 
dust  with  a wetting  agent.  The  organic  thio- 
cyanates are  compatible  and  frequently  used 
with  the  pyrethrins  and  rotenones. 

Phenothiazine,  N.F.,  although  known  since 
1883,  was  first  shown  to  have  insecticidal 
value  in  1934.  Phenothiazine  is  oxidized  in 
the  presence  of  light  and  air.  It  has  been  used 
as  a mosquito  larvicide  and  as  an  insecticide 
against  the  codling  moth,  but  its  instability 
has  yielded  erratic  results.  Both  pheno- 
thiazine and  its  oxidation  products  have  fun- 
gicidal value,  but  more  especially  pesticidal 
value  for  the  internal  parasites  of  mammals. 
It  is  combined  with  nicotine  (PN)  as  an  in- 
ternal parasiticide  for  poultry.  Phenothiazine 
should  not  be  used  externally,  since  it  sensi- 
tizes the  skin  to  light.  Dusts  should  not  be 
inhaled.  Formulae  include  capsules;  mixtures 
with  salt,  minerals,  and  feeds;  drenches  and  a 
wettable  powder. 


M.D.'S— PHARMICS  WORK  TOGETHER 

Representatives  of  a joint  committee  of  the 
State  Pharmaceutical  Association  and  the 
State  Medical  Association  met  in  Huron  Jan- 
uary 17  th. 

Purpose  of  the  meeting  was  to  discuss 
problems  common  to  the  two  professions. 
Items  for  discussion  have  not  as  yet  been  ap- 
proved by  the  two  associations. 


— 121  — 


EARL  R.  SERLES  MEMORIAL  FUND 

For  many  years  the  South  Dakota  Phar- 
maceutical Association  has  sponsored  a loan 
fund  known  as  the  South  Dakota  Pharmaceu- 
tical Association  Loan  Fund. 

At  the  annual  convention  of  the  Associa- 
tion in  Rapid  City  it  was  voted  to  establish  in 
memory  of  Dr.  Earl  R.  Series  the  Earl  R.  Ser- 
ies Memorial  Scholarship  and  Loan  Fund  and 
that  this  new  loan  fund  be  inaugurated  by 
transferring  the  funds  in  the  South  Dakota 
Pharmaceutical  Association  Loan  Fund. 

Dr.  Series  served  South  Dakota  State  Col- 
lege as  Dean  of  the  Division  of  Pharmacy 
from  1923  until  1940.  At  the  time  of  his  death 
he  held  the  position  of  Dean  and  Professor  of 
Pharmacy  at  the  University  of  Illinois. 

A committee  of  three,  appointed  by  the 
president  of  the  association,  will  administer 
the  fund.  Present  committee  members  in- 
clude W.  G.  Ray,  Robert  Matson  and  Floyd 
LeBlanc  — Chairman. 

Money  in  the  fund  will  be  available  for 
loans  to  worthy  students  of  the  Division  of 
Pharmacy.  The  interest  received  will  be  used 
to  provide  scholarships. 

Members  of  the  South  Dakota  Pharmaceu- 
tical Association,  Alumni  of  the  Division  of 
Pharmacy  and  others  are  invited  to  augment 
this  fund  with  voluntary  contributions  and 
memorials.  Contributions  to  the  Fund  should 
be  sent  to  the  Division  of  Pharmacy,  South 
Dakota  State  Colege,  Brookings,  South  Da- 
kota. 

The  names  of  those  individuals  in  whose 
honor  memorials  are  established  and  the 
names  of  those  making  contributions  will  be 
made  a permanent  part  of  the  records  of  the 
fund  and  displayed  in  an  appropriate  manner. 


GRADUATE  SPECIFICATIONS  MUST 
MEET  NEW  STANDARDS 

The  National  Bureau  of  Standards  has  set 
down  new  specifications  for  liquid  measur- 
ing devices  used  in  pharmacies.  This  action 
was  taken  following  the  40th  National  Con- 
ference of  Weights  and  Measures  which  took 
place  in  1955  and  became  effective  July  1, 
1956. 

The  specification  changes  in  pharmaceu- 
tical graduates  require  that  graduates  with 
capacity  of  four  drams  and  less  may  be  grad- 
uated in  only  one  scale,  English  or  metric, 
not  both.  A graduate  of  Vi  ounce  capacity  or 
less  must  be  cylindrical  in  shape  and  any  of 
those  over  1/2  ounce  may  be  cylindrical  or 
conical  in  shape. 

The  new  specifications  also  require  that 
the  lowest  interval  represent  not  less  than  % 
or  not  more  than  14  of  the  nominal  capacity 
of  the  graduate.  The  most  important  specifi- 
cation change  being  that  the  initial  interval 
(lowest  graduation  marking)  on  all  graduates 
larger  than  1/2  ounce  capacity  will  measure  a 
greater  volume.  The  metric  scale  will  more 
closely  follow  a true  metric  volume  system. 
The  fifteen  milliliter  graduate  will  be  dis- 
continued. The  twenty-five  milliliter  max- 
imum graduation  will  replace  the  thirty 
milliliter;  the  fifty  milliliter  will  replace  the 
sixty  milliliter;  and,  the  one  hundred  milli- 
liter will  replace  the  one  hundred  twenty-five 
milliliter. 

There  have  been  weight  and  measure  | 
specification  changes  from  time  to  time  but  1 
this  change  represents  the  original  alteration  ; 
of  pharmaceutical  graduate  specifications  ■ 
within  our  time.  State  authorities  have  been 
(Continued  on  Page  125)  ; 


— 122  — 


Fellow  Pharmacists: 

Here  we  are  back  from  a wonderful  “see  America  first”  trip  through  the  Southwestern 
part  of  the  country.  We  had  a very  relaxing  trip  and  saw  many  of  the  interesting  and  fab- 
ulous things  in  that  area.  We  also  took  the  opportunity  to  visit  as  many  pharmacists  as  pos- 
sible in  varied  types  of  cities.  In  particular,  it  was  interesting  to  talk  with  these  men  about 
their  state  pharmacy  laws  and  regulations  and  compare  them  with  our  own.  I am  happy  to 
report  that  in  many  cases  we  are  far  ahead  in  raising  the  standards  of  pharmacy.  We  can  be 
proud  of  the  efforts  of  our  Board  and  Association  in  this  respect.  I also  feel  confident  that 
South  Dakota  pharmacists  will  continue  this  good  work. 

Let’s  not  forget  that  the  annual  convention  will  be  here  in  a few  months.  We  are  hoping 
for  a large  turnout  for  this  72nd  convention  and  I know  that  the  local  committee  is  planning 
an  interesting  program. 

George  Lehr 


i 


— 123  — 


ALBAPLEX 

Descriplion:  Each  Albaplex  capsule  contains 
tetracycline  phosphate  complex  equivalent 
to  60  mg.  of  tetracycline  hydrochloride  and 
60  mg.  of  novobiocin  sodium. 

Uses  Albaplex  is  specifically  “tailored”  for 
cats  and  dogs.  The  antibiotic  compound  is 
effective  against  a wide  range  of  organ- 
isms in  the  treatment  of  respiratory, 
urinary,  gastrointestinal  and  dermatological 
infections.  Albaplex  is  also  indicated  in 
canine  coccidiosis  and  leptospirosis,  bac- 
terial complications  of  vital  diseases,  and 
in  pre  and  post-operative  prophylaxis. 

Extensive  clinical  studies  have  shown 
that  Albaplex  is  well  tolerated  by  both  cats 
and  dogs.  There  is  no  evidence  of  renal  or 
hepatic  damage,  urticaria  or  maculopapular 
dermatitis  following  administration  of  the 
new  compound. 

Dosage:  Recommended  daily  doses  for  dogs 
range  from  1 or  2 capsules  for  small  dogs 
to  6 or  8 capsules  for  extremely  large  dogs. 
One  capsule  every  twelve  hours  is  the 
recommended  dosage  for  mature  cats. 

Source:  Upjohn. 

SPENSIN 

Description:  It  is  an  antidiarrheal  containing 
activated  attapulgite,  considered  five  to 
eight  times  more  adsorptive  than  the  stand- 
ard adsorbent,  kaolin.  The  drug  aids  in  re- 
moval of  bacteria,  vacterial  toxins  and  irri- 
tants, and  helps  restore  normal  absorption 
of  fluids  and  nutrients.  It  provides  symp- 
tomatic relief  by  physical  protection  of 
irritated  intestinal  mucosa  and  produces 
firm,  well-formed  stools  of  normal  con- 
sistency. The  preparation  is  highly  palat- 
able to  adults,  children  and  infants  alike. 

Each  fluidounce  of  Spensin  contains: 
three  gm.  activated  attapulgite  and  270  mg. 


pectin  in  special  alumina  gel. 

Use:  Spensin  is  indicated  for  the  symptomatic 
treatment  of  diarrhea. 

Dosage:  Spensin  is  administered  orally  in  sus- 
pension form.  Adults:  Initially  two  table- 
spoons, then  one  tablespoonful  after  each 
bowel  movement  until  diarrhea  is  con- 
trolled. The  preparation  may  be  taken  with 
or  without  water.  Children:  One  or  more 
teaspoonfuls  according  to  age. 

Dosage  Form:  Suspension,  six  fluidounce 
bottles. 

Source:  Ives-Cameron  Company. 

PHENERGAN  EXPECTORANT 
PEDIATRIC 

Description:  Each  teaspoonful  (5  cc.)  of  Phen- 
ergan  Expectorant  Pediatric  contains  7.5  mg. 
dextromethorphan  hydrobromide,  5.0  mg. 
promethazine  hydrochloride,  0.17  min.  fluid 
extract  ipecac,  44  mg.  potassium  guaiacol- 
sulfonate,  0.25  min.  chloroform,  60  mg. 
citric  acid,  197  mg.  sodium  citrate  in  a 
pleasantly  flavored  syrup  base,  and  7%  al- 
cohol. 

Use:  Phenergan  Expectorant  Pediatric  is  in- 
dicated particularly  for  control  of  coughs 
associated  with  head  colds,  bronchitis,  in- 
flammation of  the  pharynx  and  trachea, 
laryngitis  and  asthma. 

Dosage:  Children  under  four  years  of  age, 
one-half  teaspoonful  (2.5  cc.),  one  to  four 
times  daily.  Children  over  four  years,  one 
to  two  teaspoonfuls  (5-10  cc.),  one  to  four 
times  daily. 

Dosage  Form:  Bottles  of  one  pint. 

Source:  Wyeth  Laboratories. 

CORTROPHIN-ZINC 

Description:  Each  cc.  of  Cortrophin-Zinc  pro- 
vides 20  U.S.P.  units  of  corticotropin  with 
zinc  hydroxide  (1.0  mg.  of  zinc)  for  reposi- 
tory action.  Properties:  Because  of  modifi- 


— 124  — 


MARCH  1958 


cation  of  ACTH  by  zinc  hydroxide,  each  cc. 
of  Cortrophin-Zinc  provides  therapeutic 
ACTH  activity  for  periods  of  from  1-2  days. 
It  requires  no  heating  prior  to  administra- 
tion, and  is  a fine  aqueous  suspension  which 
flows  freely  through  a 24-36  gauge  neede. 
Since  it  provides  both  prolonged  and  en- 
hanced ACTH  activity,  Cortrophin-Zinc 
may  be  given  effectively  in  lower  dosages 
and  in  fewer  injections  than  any  other  type 
of  ACTH. 

Use:  Cortrophin-Zinc  provides  the  complete 
physiologic  action  of  ACTH,  enhanced  and 
prolonged.  It  is  indicated  in  the  treatment 
of  rheumatic  afflictions,  allergic  reactions, 
skin  and  eye  diseases,  and  the  host  of  other 
stressful  conditions  amenable  to  ACTH 
therapy,  especially  where  natural  stimula- 
tion of  adrenocortical  function  is  desired. 

Dosage:  Must  be  individualized  for  each  pa- 
tient. 

Dosage  Form:  1 cc.  disposable  syringe  and  5 
cc.  vial. 

Source:  Organon,  Inc. 

PANALBA  KM 

Description:  When  granules  are  mixed  with 
sufficient  water,  48  cc.,  to  fill  bottles  to  total 
volume  of  60  cc.,  each  teaspoonful  (5  cc.)  of 
flavored  suspension  contains:  Panmycin 
(tetracycline  hydrochloride)  125  mg.,  Alba- 
mycin  (novobiocin  calcium)  62.5  mg.  and 
Potassium  Metaphosphate  100  mg. 

Uses:  All  the  breadth  and  efficiency  of  Pan- 
mycin with  potassium  metaphosphate  to 
improve  absorption  — fortified  with  Alba- 
mycin  to  increase  antimicrococcal  activity. 
Noncross-resistant  components  especially 
prepared  to  extend  the  benefits  of  com- 
bined therapy  to  the  field  of  pediatrics. 
Flavored  Granules  Panalba  KM  are  well 
suited  to  pediatric  use  from  the  standpoint 
of  stability,  dosage  flexibility,  palatability 
and  efficacy.  It  brings  to  bear  against  in- 
fection two  of  the  most  effective  antibiotics 
against  the  two  most  frequently  involved 
groups  of  bacteria  — staphylococci  and 
streptococci. 

Dosage:  Children:  1 teaspoonful  per  15  to  20 
pounds  of  body  weight  per  day  in  either 
two,  three  or  four  equally  divided  doses. 
Adults:  2 to  4 teaspoonfuls  three  or  four 
times  a day. 

Dosage  Form;  In  60  cc.  bottles. 

Source:  The  Upjohn  Company. 


MYCIFRADIN-N 

Description:  An  effective  combination  of  the 
antibiotic  neomycin  sulfate  and  antifungal 
nystatin.  Each  tablet  contains  Neomycin 
0.5  Gm.  and  Nystatin  125,000  units. 

Uses:  In  preoperative  preparation  of  the 
bowel  for  surgery  this  combination  broad- 
ens the  spectrum  of  Mycifradin  to  include 
the  potentially  hazardous  yeast-like  fungi, 
which  may  appear  in  abnormal  quantities 
particularly  when  therapy  is  extended  be- 
yond 72  hours.  Singly,  Mycifradin  is  vir- 
tually unabsorbed  from  the  G.  I.  tract;  is 
rapidly  concentrated  in  the  gut  in  high  bac- 
tericidal concentration;  can  eliminate  most 
of  the  intestinal  bacteria  in  4 to  12  hours; 
continues  to  act  as  long  as  feces  are  re- 
tained; does  not  irritate  the  intestinal  mu- 
cosa; promotes  tissue  healing;  is  highy 
water  soluble  and  leaves  no  chalky  resi- 
due on  the  bowel  wall;  is  not  an  antibiotic 
which  is  generally  used  in  the  treatment  of 
infection,  thus  does  not  favor  the  develop- 
ment of  resistance  to  widely  used  anti-bac- 
terial agents;  is  easily  administered;  and 
has  a uniformly  mild  laxative  effect-aids 
mechanical  cleansing  of  the  bowel.  Ny- 
statin is  poorly  absorbed;  remains  in  the 
gut  to  exert  its  antimonilial  action;  and  ex- 
hibits effective  antimonilial  prophylaxis. 

Dosage:  1.  Low  residue  diet. 

2.  Administer  a saline  cathartic. 

3.  Immediately  after  the  cathartic 
give  2 tablets  of  Mycifradin-N  and  repeat 
every  4 hours  for  a total  of  6 doses  (12 
tablets).  Preoperative  treatment  is  usually 
24  hours  but  can  be  extended  to  a max- 
imum of  72  hours,  at  the  same  dose  sched- 
ule of  2 tablets  every  4 hours. 

Contraindications:  Intestinal  obstruction. 

Dosage  Form:  Compressed  tablets  Mycifra- 
din-N in  bottles  of  20,  100  and  500. 

Source:  The  Upjohn  Company. 


EDITORIAL  PAGE— 

(Continued  from  Page  122) 
rather  liberal  in  permitting  the  use  of  other 
kinds  of  equipment  made  to  old  specifications 
for  the  normal  expected  life  of  the  device. 
However,  some  states  require  that  any  new 
equipment  shipped  into  the  states  must  com- 
ply with  the  latest  specifications. 


— 125  — 


_ PHARMACY 

jV 


s. 


STUDENTS  SPONSOR 

HEART  FUND  DRIVE 

The  1958  slogan  for  the  an- 
nual fund  raising  campaign 
of  the  American  Heart  Asso- 
ciation was  “For  every  heart 
you  love  — help  your  Heart 
Fund.” 

Approximately  100  stu- 
dents and  faculty  of  the  Di- 
vision of  Pharmacy,  South 
Dakota  State  College  took 
this  seriously  on  Heart  Sun- 
day, February  23  when  they 
conducted  the  annual  drive 
in  the  city  of  Brookings. 

Leadership  for  the  project 
was  provided  by  members  of 
the  newly  formed  Kappa  Psi 
Club  at  the  college.  Members 
acted  as  area  captains,  as- 
sembled all  of  the  campaign 
literature  and  workers  kits 
and  distributed  display  ma- 
terial. 

The  Kappa  Psi  Club  is  a 
professional  men’s  fraternity 
for  pharmacy  students.  It  is 
a temporary  organization  in 
the  process  of  making  pe- 
tition for  establishing  a chap- 
ter of  the  Kappa  Psi  National 
Pharmaceutical  Fraternity 
on  the  State  College  Campus. 


A.PH.A.  1958 

CONVENTION 

ANNOUNCEMENT 

The  1958  Convention  of  the 
American  Pharmaceutical 
Association  will  be  held  in 
Los  Angeles,  California,  the 
week  of  April  20.  This  will 
be  the  105th  meeting  in  the 
106  years  which  have  elapsed 
since  the  founding  of  the  As- 
sociation in  1852.  Meetings 
of  the  Association  and  affil- 
iated and  related  bodies  have 
been  held  annually,  except 
1861  and  1945.  These  were 
years  in  which  wars  pre- 
vented the  holding  of  conven- 
tions. 

The  Biltmore  Hotel  will  be 
headquarters  of  the  Conven- 
tion and  practically  all  meet- 
ings and  other  functions  will 
be  held  there. 

It  is  anticipated  that  the 
National  Conference  of  State 
Pharmaceutical  Association 
Secretaries  will  begin  its 
meeting  on  Saturday,  April 
19th.  The  American  Associa- 
tion of  Colleges  of  Pharmacy, 
the  American  College  of 
Apothecaries  and  the  Amer- 
ican Society  of  Hospital 
Pharmacists  will  open  their 
sessions  on  Sunday,  April 
20th.  The  National  Associa- 


tion of  Boards  of  Pharmacy 
meeting  will  open  on  Monday 
morning,  April  21st.  The 
American  Pharmaceutical 
Association  will,  as  usual, 
hold  opening  exercises  for 
the  combined  organizations 
on  Sunday  evening,  April 
20th,  and  will  begin  its  con- 
vention formally  with  the 
first  General  Session  either 
Monday  or  Tuesday  evening 
April  21st  or  22nd. 

In  addition  to  the  direct 
bulletin  covering  various  de- 
tails of  the  Convention  which 
will  be  sent  to  each  member 
of  the  A.Ph.A.  by  mail  in  the 
near  future,  a complete  ten- 
tative program  of  the  Con- 
vention will  appear  in  the 
March  issue  of  the  Practical 
Pharmacy  Edition  of  the 
Journal  of  the  American 
Pharmaceutical  Association. 


PHARMASCOOPS 

A meeting  of  the  Sioux 
Falls  Pharmaceutical  Asso- 
ciation was  held  January  8 at 
Stacy’s  Cafe.  Mr.  George 
Gibson,  Eli  Lilly  representa- 
tive, introduced  a movie  “In 
These  Hands.”  This  very  in- 
teresting film  showed  var- 
ious procedures  involved  in 
drug  manufacturing. 


— 126  — 


in 


anti-inflammatory  effects 
with  lower  dosage 
(averages  1/3  less  than 


prednisone) 


it 


' “ “ - in  the  collateral 

hormonal  effects  associated 
with  all  previous  corticosteroids 

I No  sodium  or  water  retention 
0 No  potassium  loss 

$ No  interference  with  psychic  equilibrium 
0 Low  incidence  of  peptic  ulcer  and  osteoporosis 


Aristocort  is  available  in  8 mg.  scoi'ed  tablets  (pink),  bottles  of  30;  and  4 mg,  scored  tablets  (white),  bottles  of  30  and  100. 


The  Achievement  in  Skin  Diseases:  In  a study  of  26  patients  with  severe 
dermatoses,  aristocort  was  proved  to  have  potent  anti-inflammatory  and  antipruritic  properties, 
even  at  a dosage  only  % that  of  prednisone.'. . . Striking  affinity  for  skin  and  tremendous  potency  in 
controlling  skin  disease,  including  50  cases  of  psoriasis,  of  which  over  60%  were  reported  as 
markedly  improved".,  .absence  of  serious  side  effects  specifically  noted.*’®’® 


The  Achievement  in  Rheumatoid  Arthritis:  Impressive  therapeutic  effect 
in  most  cases  of  a group  of  89  patients'*. . .6  mg.  of  aristocort  corresponded  in  effect  to  10  mg.  of 
prednisone  daily  (in  addition,  gastric  ulcer  which  developed  during  prednisone  therapy  in  2 cases 
disappeared  during  aristocort  therapy).'* 


1.  Rein,  C.  R.,  Fleischmajer,  R.,  and  Rosenthal,  A.  L.:  J.  A.  M.  A. 
165:1821,  (Dec.  7)  1957. 

2.  Shelley,  W.  B.,  and  Pillsbury,.D.  M. : Personal  Communication. 

3.  Sherwood,  A.,  and  Cooke,  R.  A. : Personal  Communication. 

4.  Freyberg,  R.  H.,  Berntsen,  C.  A.,  and  Heilman,  L.:  Paper 
presented  at  International  Congress  on  Rheumatic  Diseases,  Toronto, 
June  25,  1957. 

5.  Hartung,  E.  F.:  Personal  Communication. 

6.  Schwartz,  E.:  Personal  Communication. 

7.  Sherwood,  A.,  and  Cooke,  R.  A.:  J.  Allergy  28:97,  1957. 

8.  Heilman,  L.,  Zumoff,  B.,  Kretshmer,  N.,  and  Kramer,  B.:  Paper 
presented  at  Nephrosis  Conference,  Bethesda,  Md.,  Oct.  26, 1957. 

9.  Ibid. : Personal  Communication. 

10.  Barach,  A.  L.:  Personal  Communication. 

1 1.  Segal,  M.  S.:  Personal  Communication. 

12.  Cooke,  R.  A.:  Personal  Communication. 

13.  Dubois,  E.  L.:  Personal  Communication. 


The  Achievement  in  Respiratory  Allergies:  “Good  to  excellent”  results 

in  29  of  30  patients  with  chronic  intractable  bronchial  asthma  at  an  average  daily  dosage  of  only 
7 mg.®. . . Average  dosage  of  6 mg.  daily  to  control  asthma  and  2 to  6 mg.  to  control  allergic  rhinitis 
in  a group  of  42  patients,  with  an  actual  reduction  of  blood  pressure  in  12  of  these.^ 

The  Achievement  in  Other  Conditions:  Two  failures,  4 partial  remissions 
and  8 cases  with  complete  disappearance  of  abnormal  chemical  findings  lead  to  characterization 
of  ARisTOCORT  as  possibly  the  most  desirable  steroid  to  date  in  treatment  of  the  nephrotic  syn- 
drome.®’®. . . Prompt  decrease  in  the  cyanosis  and  dyspnea  of  pulmonary  emphysema  and  fibrosis, 
with  marked  improvement  in  patients  refractory  to  prednisone.'®’ Favorable  response 
reported  for  25  of  28  cases  of  disseminated  lupus  erythematosus.'® 


—OH 


Depending  on  the  acuteness  and  severity  of  the  disease  under  therapy,  the  initial 
dosage  of  aristocort  is  usually  from  8 to  20  mg.  daily.  When  acute 
manifestations  have  subsided,  maintenance  dosage  is  arrived  at  gradually, 
usually  hy  reducing  the  total  daily  dosage  2 mg.  every  3 days  until  the  smallest 
dosage  has  been  reached  which  will  suppress  symptoms. 


Comparative  studies  of  patients  changed  to  aristocort  from  prednisone 
indicate  a dosage  of  aristocort  lower  by  about  Vi  in  rheumatoid  arthritis, 
by  Vi  in  allergic  rhinitis  and  bronchial  asthnia,  and  by  Vi  to  Vz  in  inflammatory 
and  allergic  skin  diseases.  With  aristocort,  no  precautions  are  necessary 
in  regard  to  dietary  restriction  of  sodium  or  supplementation  with  potassium. 


aristocort  is  available  in  2 mg.  scored  tablets  (pink),  bottles  of  30; 
and  4 mg.  scored  tablets  (white),  bottles  of  30  and  100. 


LEDBRLB  LABORATOBIES  DIVISION,  AMKKICAN  CYANAMID  COMPANY.  PEARL  RIVER  NEW  YORK 


ri'ji^ii.'^buehter,  &t>. 


A*H*. 


QUINtNE 


ATABRINE« 

HYDROCHLORIDE 


ARALEN 

PHOSPHATE 


CHjCHaOH 


NHCH‘CH,CH,CH,N 


S.D.J.O.M.  MARCH  1958  - ADV. 


41 


IN  ALL  DIARRHEAS . . . REGARDLESS  OF  ETIOLOGY 

CREMOMYCIN 


comprehensive  control 

with 


SULFASUXlDlNEl  PECTIN-KAOLIN-NEOMYCIN  SUSPENSION 


SOOTHING  ACTION . . . Kaolin  and  pectin  coat  and  soothe  the  inflamed  mucosa,  ad- 
sorb toxins  and  help  reduce  intestinal  hypermotility. 

BROAD  THERAPY . . . The  combined  antibacterial  effectiveness  of  neomycin  and 
Sulfasuxidine  is  concentrated  in  the  bowel  since  the  absorption  of  both  agents 
is  negligible. 


LOCAL  IRRITATION  IS  REDUCED  and  control  is  instituted  against  spread  of  infective 
organisms  and  loss  of  body  fluid. 


PALATABLE  creamy  pink,  fruit-flavored  cremomycin  is  pleasant  tasting,  readily 
accepted  by  patients  of  all  ages. 

* Sulfasuxidine  is  a trade-mark  of  Merck  & Co.,  Inc.  LydS^Qi 


MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  & CO.,  Inc.,  PHIUDELPHIA  1,  PA. 


42 


S.D.J.O.M.  MARCH  1958  - ADV. 


NEW  MAGAZINE  FOR  PHYSICIANS 

Timely  statistical  ‘profiles’  on  major  health 
problems,  ranging  from  allergic  ailments  to 
cardiovascular  disease,  from  the  theme  of  a 
new  monthly  publication,  “Patterns  of  Di- 
sease.” 

Major  aims  of  “Patterns,”  are  to  provide  in- 
formation which  physicians  can  use  to  antici- 
pate health  problems  in  their  areas;  to  deter- 
mine which  diseases  they  will  encounter  most 
often  among  various  age  groups  and  in  var- 
ious localities;  and  to  choose  fields  of  spec- 
ialty most  useful  to  their  own  communities. 
For  instance,  midwestern  physicians,  reading 
in  the  first  issue  of  “Patterns”  of  the  high 
concentration  of  older  people  in  their  area, 
may  decide  to  place  more  emphasis  on 
geriatrics. 

“Changing  national  patterns  of  health  can 
mean  changing  habits  of  practice,”  says  Gray- 
don  L.  Walker,  vice-president  and  director  of 
sales  and  promotion  for  Parke  Davis,  pub- 
lisher of  the  magazine. 

“Patterns”  will  familiarize  physicians  with 


these  changes  by  presenting  in  “pictograph 
form  statistics  on  all  aspects  of  commonly  en- 
countered medical  problems,”  according  to 
Mr.  Walker. 

The  publication  also  incorporates  Parke- 
Davis’  “Pediatric  Patters,”  the  only  monthly 
source  of  information  on  the  incidence  of  five 
common  communicable  childhood  diseases 
broken  down  by  states  and  cities. 

Future  issues  of  the  publication,  say  Parke- 
Davis  spokesmen,  will  deal  with  such  topics 
as  cardiovascular  disease,  arthritis,  allergic 
diseases,  diabetes,  and  mental  health. 

The  first  issue,  now  being  mailed  to  140,000 
physicians  throughout  the  country,  is  devoted 
to  the  growing  problem  of  America’s  aged 
population.  It  deals  with  such  questions  as; 
“Where  do  our  older  people  live?”  “What 
does  our  longer  life  span  mean?”  “What  type 
of  care  will  the  aged  require?”  “How  much 
will  it  cost?” 

Maximum  concentrations  of  older  people, 
“Patterns”  reveals,  are  in  such  far-flung  areas 


S.D.J.O.M.  MARCH  1958  - ADV. 


43 


as  the  New  England  states,  the  Great  Plains 
states,  and  in  Florida,  rather  than  the  Gulf 
states  and  on  the  West  Coast,  as  is  widely  be- 
lieved. 

I The  publication  also  stresses  the  growing 
I number  of  aged  people  in  our  population, 
especially  women.  Since  1900,  it  states,  the 
population  of  the  United  States  has  almost 
doubled  but  the  number  of  persons  aged  65 
and  older  has  more  than  quadrupled.  In  1975 
it  is  estimated  that  10  in  every  100  Americans 
will  be  in  the  older  age  group,  and  six  of  these 
will  be  women. 

■ Our  life  span,  says  “Patterns,”  has  in- 
j creased  from  less  than  50  years  in  1900  to 
j slightly  over  70  now. 

This  rapid  increase  in  life  expectancy,  how- 
ever, is  coupled  with  a rise  in  the  death  rates 
for  the  chronic  diseases,  with  heart  disease 
exacting  a heavier  toll  than  all  other  diseases 
combined,  according  to  the  publication.  Heart 
disease,  too,  ranks  as  the  commonest  chronic 
disease,  afflicting  well  over  half  of  the  older 
age  group.  Other  major  health  problems  in 
this  group  include  arthritis  and  obesity. 

Who  takes  care  of  the  aged?  Nursing  homes 


rank  highest  in  this  respect,  with  90  per  cent 
of  their  population  in  the  65-and-over  age 
group,  “Patterns”  reports.  Next,  are  institu- 
tions for  chronic  diseases  in  which  65  per  cent 
of  the  beds  are  occupied  by  the  older  age 
group.  The  figure  is  53.3  per  cent  for  con- 
valescent and  rest  homes,  21.6  per  cent  for 
nervous  and  mental  hospitals,  18.2  per  cent 
for  general  hospitals. 

Care  for  the  aged  imposes  a heavy  financial 
drain,  the  publication  discloses.  Although 
they  comprise  only  nine  per  cent  of  the  pop- 
ulation, they  incur  13  per  cent  of  the  costs 
for  all  private,  personal  health  services. 

The  average  aged  person  spends  about  $122 
per  year  for  medical  care  as  against  $78  for 
the  general  population. 

On  what  lies  ahead  for  the  aged,  “Patterns” 
predicts  that  more  demands  will  be  made  on 
specialists  in  the  future.  “Severely  disabled 
older  persons  need  medical  checkups  on  the 
average  of  once  every  two  months,”  accord- 
ing to  the  publication. 

It  stresses,  however,  that  with  “adequate 
care,  improvement  of  health  or  halting  the 
progression  of  chronic  disease  can  be  expec- 
ted in  41  per  cent  of  those  65  years  and  over.” 


^ARABROMOYLAMINE  MALEATE) 

® 


1 1 


TABLETS  f4MG.T  ELIXIR  (2  MG.  PER  5 CC.) 
AND  EXTENTABS®  (12  MG,)J 


NEXCELLED  ' 
©THERAPEUTIC 
FETY.  MINIMUM 

Other  side  effects. 

, RICHMOND,  VIR- 
MACEU- 


44 


S.DJ.O.M.  MARCH  1958  - ADV. 


A NEW,  CORTICOSTEROID  MOLECULE  WITH  GREATER  ANTIALLERGIC, 
ANTIRHEUMATIC  AND  ANTI-INFLAMMATORY  ACTIVITY 


■ far  less  gastrointestinal 
distress 


■ safe  to  use  in  asthma  with 
associated  cardiac  disease; 
no  sodium  and  water  retention 

■ does  not  produce  secondary 
hypertension— low  salt  diet 
not  necessary 

■ no  unnatural  psychic 
stimulation 

■ often  works  when  other 
glucocorticoids  have  failed 

■ and  on  a lower  daily  dosage 
range 


Initial  dosage:  8 to  20  mg.  daily.  After  2 to  7 days 
gradually  reduce  to  maintenance  levels. 

See  package  insert  for  specific  dosages  and  precautions. 
1 mg.  tablets,  bottles  of  50  and  500. 

4 mg.  tablets,  bottles  of  30  and  100. 


Squibb  Quality~the  Priceless  Ingredient 


‘KENAeORT' 


SQUIBB  TRADEMARK 


S.D.J.O.M.  MARCH  1958  - ADV. 


45 


1 


4- 


/ itl^9  57 


uma 

INSURANCE  COMPANY  OF  IOWA  — 

INSURANCE  COSTS  with  DRUGGISTS'  MUTUAL  were  at  an 


All-Time  LOW 


PER  $1,000 
OF  INSURANCE 


for  19  5 8 


DIVIDENDS  on  DRUGGISTS^  MUTUAL  POLICIES  will  again  be 


25^»  or  MORE 


ON  STORE  & 
HOME  INSURANCE 


HOME  OFFICES 
ALGONA,  IOWA 

All  Policies  Non-Assessable 


when  anxiety  and  tension  "erupts”  In  the  G.  I.  tract... 

IN  ILEITIS 


PATHIBAMATE' 

Meprobamate  with  PATHILON®  Lederle 

Combines  Meprobamate  (400  mg.)  the  most  widely  prescribed  tranquilizer  . . . helps  control 
the  “emotional  overlay”  of  ileitis  • without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . with  PATHILON  (25  mg.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 

^Trademark  ® Registered  Trademark  for  Tridihex^thyl  Iodide  Lederle 


LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 


46 


S.D.J.O.M.  MARCH  1958  - ADV. 


Therapeutic  Nutrition  in  Chronic  Disease 


and  Protein  Nutrition 
in  Vascular  Disease 


V V hether  the  eventual  solution  of  the  problem  of 
athero genesis  will  come  out  of  the  field  of  dietetics,  bio- 
physics, or  pharmacology,  one  fact  remains  undeniable: 

Adequate  protein  nutrition  is  considered  of  impor- 
tance for  the  age  group  most  commonly  affected  by 
disease  of  the  vascular  system,  so  that  the  demands  of 
good  nutritional  health  might  be  met. 

Meat  is  outstanding  among  protein  foods.  It  supplies 
all  the  essential  amino  acids,  and  closely  approaches  the 
quantitative  proportions  needed  for  biosynthesis  of 
human  tissue. 

In  addition,  it  is  an  excellent  source  of  B vitamins, 
including  Be  and  B12,  as  well  as  iron,  phosphorus,  potas- 
sium, and  magnesium. 

When  curtailment  of  fat  intake  is  deemed  indicated, 
meat  need  not  always  be  denied  the  patient.  Visible  fat 
obviously  should  not  be  eaten.  But  the  contained  per- 
centage of  invisible  (interstitial)  fat  is  well  within  the 
limits  of  reasonable  fat  allowance. 

The  nutritional  statements  made  in  this  advertisement 
have  been  reviewed  by  the  Council  on  Foods  and  Nutri- 
tion of  the  American  Medical  Association  and  found 
consistent  with  current  authoritative  medical  opinion. 

American  Meat  Institute 

Main  Office,  Chicago. ..Members  Throughout  the  United  States 


! 


‘ S.DJ.O.M.  MARCH  1958  - ADV. 


47 


for  'This  Wormy  World” 


Pleasant  tasting 

'ANTEPAR’ 

PIPERAZINE 

SYRUP  • TABLETS  • WAFERS 


Eliminate  PINWORMS  IN  ONE  WEEK 
ROUNDWORMS  IN  ONE  OR  TWO  DAYS 

PALATABLE  • DEPENDABLE  • ECONOMICAL 


‘ANTEPAR’  SYRUP  ~ Piperazine  Citrate,  100  mg.  per  cc. 
^ANTEPAR’  TABLETS  “Piperazine  Citrate,  250  or  500  mg.,  scored 
^ANTEPAR^  WAFERS  “ Piperazine  Phosphate,  500  mg. 


Lilerature  available  on  request 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  Tuckahoe,  N.  Y. 


48 


S.D.J.O.M.  MARCH  1958  - ADV. 


See  anybody  here  you  know,  Doctor? 


Fm  just  too  much 


:4^\AMPLUS 


4 


for  sound  obesity  management 

dextro-amphetamine  plus  vitamins 
and  minerals 


Fm  too  little 


STIMAVITE 


stimulates  appetite  and  growth 

vitamins  Bi,  Be,  B12,  C and  L-lysine 


Fm  simply  two 


OBRON® 

a nutritional  buildup  for  the  OB  patient 

OBRON^ 

HEMATINIC 

when  anemia  complicates  pregnancy 


And  Fm  getting  brittle 


NEOBON^ 

5-factor  geriatric  formula 

hormonal,  hematinic  and 
nutritional  support 


With  my  anemia, 
Fll  never  make  it  up 
that  high 


k® 


ROETINIC 

one  capsule  a day,  for  all  treatable  anemias 

HEPTUNA^  PLUS 

when  more  than  a hematinic  is  indicated 


solve  their  problems  with  a nutrition  product  from 


( Prescription  information  on  request) 


New  York  17,  New  York 
Division.  Chas.  Pfizer  & Co.,  Inc. 


S.D.J.O.M.  MARCH  1958  - ADV. 


49 


NEW ] “flavor-timed”  dual-action 

CORONARY  VASODILATOR 


ORAL  (toiblet  swollowed:  wfeole) 

for  dependable  prophylaxis 

SUBLINGUAL-ORAL 

for  immediate  and 

sustained  reUef 


TRADfMARK 


ANGINA  PECTORIS 


NITROGLYCERIN - 

0.4  mg.  (1/150  grain)  — acts  quickly 

CITRUS  "FlAVOR-TIMiR"™ 

signals  patient  when  to  swallow 

PENTAIRYTHRITOL  TETRANITRAIE  — 

15  mg.  (1/4  grain)  — prolongs  action 


For  continuing  prophylaxis  patient  swallows 
the  entire  Dilcoron  tablet. 

Average  prophylactic  dose: 

1 tablet  four  times  daily. , 

Therapeutic  dose: 

1 tablet  held  under  the  tongue  until  citrus 
flavor  disappears,  then  swallowed. 

Bottles  of  100. 


LABORATORIES  NEW  y@ik  tl.  N.  V. 


1247M 


when  anxiety  and  tension  "erupts”  in  the  G.  I.  tract... 

IN  GASTRIC  ULCER 


PATHIBAMATE 

Meprobamate  with  PATHILON®  Lederls 


Combines  Meprobamate  {400  mg.)  the  most  widely  prescribed  tranquilizer  . . . helps  control 
the  “emotional  overlay”  of  gastric  ulcer  — without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . with  PATH  ILON  {25  mg.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.L  disorders. 

Hosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000.. 

‘Trademark  ® Registered  Trademark  for  Tridihexethy!  Iodide  Lederle 

LEDERLE  LABORATORIES  DIVISION.  AMERICAN  CYANAMID  COMPANY.  PEARL  RIVER.  NEW  YORK 


50 


S.D.J.O.M.  MARCH  1958  - ADV. 


i 

I^cc&s 

A few  suggestions  on  how  to  give  your  patient  a diet  he  can  ‘‘stick  to’ 

The  Low 
Calorie  Diet 


—and  a glass 
of  beer,  at 
your  discretion, 
for  a 
morale-booster 


A diet  that  calls  for  lamb  chops  when  they 
aren’t  on  the  restaurant  menu  is  an  invitation 
to  “slip  oif.”  But  a diet  outline  that  lets 
yom  patient  fill  in  the  details  provides  incen- 
tive to  stick  to  his  diet. 

He  must  remember  that  a candy  bar  equals 
a hamburger  in  calories  only.  An  alternative 
must  be  equivalent  in  nutrition,  too. 


Fresh  fruits  or  vegetables  such  as  celery 
and  radishes  make  good  low-calorie  nibbles. 
Spices  and  herbs,  lemon  and  vinegar  add 
zest  with  few  or  no  calories. 

Have  yom  patient  keep  a calorie  count. 
Then  with  a glass  of  beer  * to  brighten  meals,  he 
is  more  likely  to  follow  a balanced  diet  later. 

*104  Calories/8  oz.  glass  (Average  of  American  Beers) 


United  States  Brewers  Foundation 

Beer — America’s  Beverage  of  Moderation 

If  you’d  like  reprints  of  1 2 special  diets,  please  write  United  States  Brewers  Foundation,  535  Fifth  Avenue,  New  York  1 7,  N.  Y. 


S.DJ.O.M.  MARCH  1958  - ADV. 


51 


THE  MONTH  IN 
WASHINGTON— 

(Continued  from  Page  99) 
Department  and  the  Soviet 
government.  Also  planned 
are  exchanges  of  medical 
journals  between  medical  li- 
braries and  of  medical  films. 
All  these  are  part  of  a broad 
scientific,  cultural  and  educa- 
tion program  between  the 
two  nations.  Details  haven’t 
been  worked  out. 


Six  members  of  the  Health 
Resources  Advisory  Commit- 
tee have  been  named  by  De- 
fense Mobilizer  Gordon 
Gray.  The  committee,  headed 
by  Dr.  Elmer  Hess,  advises 
government  on  health  and 
medical  problems  in  time  of 
war  or  national  emergency. 
Members  are  Dr.  George  C. 
Whitecotten,  Oakland,  Calif., 
Dr.  Franklin  Yoder,  Chey- 
enne, Wyo.,  Dr.  Mary  Louise 
Gloechner,  Conshocken,  Pa., 


Harold  Oppice,  DDS,  Chicago, 
Dr.  William  Walsh,  Washing- 
ton, D.  C.,  and  Frances  Graff, 
RN,  Grand  Rapids,  Mich. 


BOARD  EXAMINES  FIVE 

Five  new  physicians  have 
been  licensed  to  practice  in 


OHIT 

**-'«ostU  insuiimeiits 


-to 


fhe  instrument  - its 

t*  A rpadv  to  use.  ue 

/ *1,  two  instruments— 

:nre"«„t  changmg  oi 
ion  1 .oith  rbeostat 

fisS^Jetd'voUaae.e,. 

ips  last  longer. 


Ho.  745  . 


.$60.00 


KREISER  SURGICAL  Inc. 

Sioux  Falls,  S.  D.  Rapid  City,  S.  D. 

1220  S.  Minnesota  528  Kansas  City  St. 


South  Dakota  as  a result  of 
recent  examinations. 

Given  temporary  licenses 
were  Dr.  Lisellotte  Marr  who 
is  permitted  to  practice  four 
years  at  Estelline,  and  Dr. 
Werner  Klar  who  will  locate 
in  Geddes  under  the  same 
arrangements.  Dr.  G.  J.  Car- 
stens  was  granted  full  licen- 
sure and  will  practice  in 
South  Dakota  as  soon  as  he 
completes  his  internship  at 
Cedar  Rapids.  Dr.  Karl  Illig 
completed  his  examinations 
and  will  be  licensed  upon 
certification  by  the  Board  of 
Examiners  in  the  Basic 
Sciences.  Dr.  Matthew  Na- 
mikas,  now  at  Fort  Campbell, 
Ky.  will  locate  in  Sioux  Falls. 

Thirteen  physicians  have 
been  licensed  in  South  Da- 
kota by  reciprocity  since  the 
last  Board  meeting  in  July. 


52 


S.D.J.O.M.  MARCH  1958  - ADV. 


there  is  one  tranquilizer  clearly  indicated  id  psptiC  UlCBL.. 


*Tests  in  a series  of  25  patients  show  that 
there  is  “a  definite  and  distinct  lowering 
[of  both  volume  of  secretions  and  of  free 
hydrochloric  acid]  in  the  majority  of 
patients.  . . . No  patients  had  shown  any 
increase  in  gastric  secretions  following  ad- 
ministration of  the  drug.”^ 

Now  you  have  4 advantages  when 
you  calm  ulcer  patients  with  atarax  : 

1.  ATARAX  suppresses  gastric  secretions; 
others  commonly  increase  acidity. 

2.  ATARAX  is  “the  safest  of  the  mild  tran- 
quilizers.”® (No  parkinsonian  effect 
or  blood  dyscrasias  ever  reported.) 

3.  It  is  effective  in  9 of  every  10  tense 
and  anxious  patients. 

4.  Five  dosage  forms  give  you  maximum 
flexibility. 

supplied;  10,  25  and  100  mg.  tablets,  bottles  of 
100.  Syrup,  pint  bottles.  Parenteral  Solution, 
10  cc.  multiple-dose  vials. 

references;  l.  Strub,  I.  H. : Personal  commu- 
nication. 2.  Ayd,  F.  J.,  Jr.:  presented  at  Ohio 
Assembly  of  General  Practice,  7th  Annual 
Scientific  Assembly,  Columbus,  September  18- 
19,  1957. 


New  York  17,  New  York 

Division,  Chas.  Pfizer  & Co.,  Inc. 


S.D.J.O.M.  MARCH  1958  - ADV. 


53 


PRESTIGE 

PRESCRIPTION 

PRODUCTS 


BUILD  CUSTOMER  CONFIDENCE... 

Feature  quality  pharmaceuticals 


WE  ARE  A 


DISTRIBUTOR 


Customer  confidence,  the  very  foundation 
of  an  expanding,  profitable  prescription 
business,  cannot  be  bought  ...  it  must  be 
earned.  Therefore,  confidence  is  worth  culti- 
vating. It  is  based  on  many  things — respect 
for  integrity  and  ethics,  competent  per- 
sonnel, the  professional  appearance  of  your 
prescription  department,  uniform  refills,  and 
high-quality  merchandise. 

To  enhance  the  prestige  of  your  professional 
service,  feature  the  finest  in  pharmaceuticals 
. . . those  bearing  the  Lilly  label.  For  com- 
petent service,  send  your  orders  to  us. 

BROWN  DRUG  COMPANY 

Sioux  Falls,  South  Dakota 


when  anxiety  and  tension  "erupts”  In  the  G.  I.  tract... 

IN  DUODENAL  ULCER 


PATH  I BAM  ATE 


* 


Meprobamate  with  PATH  I LON®  Lederlo 

Combines  Meprobamate  {400  mg’.)  the  most  widely  prescribed  tranquilizer  . . . helps  control 
the  “emotional  overlay”  of  duodenal  ulcer  — without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . with  PATH  I LON  (25  fng.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 

^Trademark  ® Registered  Trademark  for  Tridihexefhyl  Iodide  Lederle 

LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER,  NEW  YORK 


54 


S.DJ.O.M.  MARCH  1958  - ADV. 


the  chill 


the  cough 

the  aching  muscles 


the  fever 


Viral  upper  respiratory  infection. . . . For  this  patient,  your  management  will  be  twofold — 
prompt  symptomatic  relief  plus  the  prevention  and  treatment  of  bacterial  complications. 
PEN•VEE•C^d^?^  backs  your  attack  by  broad,  multiple  action.  It  relieves  aches  and  pains,  and 
reduces  fever.  It  counters  depression  and  fatigue.  It  alleviates  cough.  It  calms  the  emotional 
unrest.  And  it  dependably  combats  bacterial  invasion  because  it  is  the  only  preparation  of  its 
kind  to  contain  penicillin  V. 

SUPPLIED:  Capsules,  bottles  of  36.  Each  capsule  contains  62.5  mg.  (100,000  units)  of  penicillin  V,  194  mg.  of 
salicylamide,  6.25  mg.  of  promethazine  hydrochloride,  130  mg.  of  phenacetin,  and  3 mg.  of  mephentermine  sulfate. 

Pen  -Vee  • Cidin 

Penicillin  V with  Salicylamide,  Promethazine  Hydrochloride,  Phenacetin,  and  Mephentermine  Sulfate,  Wyeth  Philadelphia  1,  Pa. 


This  advertisement  con- 
forms to  the  Code  for 
Advertising  of  the  Physi- 
cians’ Council  for  Infor- 
mation on  Child  Health. 


S.D.J.O.M.  MARCH  1958  - ADV. 


55 


IN  THB  MANAGSMENT 
OF  DERIVIATOSBS  . . , 

(Regardless  of  Previous  Refraci oriness) 

Confirmed  by 
an  impressive  and 
growing  body  of  published 
clinical  investigations 


^ CREAM 

Hydrocortisone  O.S%  and  Special  Coal  Tar  Extract  5% 
(TARBONIS®)  in  a greaseless,  stainless  vanishing  cream  base. 


A M JLJJ  .m  JLa  ^ A Jk  JL  A M oi  ntm  e nt 

Hydrocortisone  O.S%.  Neomycin  0.35%  (as  Sulfate)  and  Special 
Coal  Tar  Extract  5%  (TARBQNIS)  in  an  ointment  base. 


J.  A.M.A.  f6®:168,1958;  Welsh, A.L.  and Ede,M. 

.prompt  remissions  of  ...acute  phases.” 

with  TARCORTIN 


REED  & CARNRICK  / Jersey  City  6»  New  Jersey 


* 


1.  Clyman,  S.  G.:  Postgrad.  Med.  2i:309,  1957. 

2.  Bleiberg,  J.:  J.  M.  Soc.  New  Jersey  5J:37,  1956. 

3.  Abrams,  By.  F,  and  Shaw,  C.:  Clin.  Med.  J:839,  1956. 

4.  Welsh,  A.  L.,  and  Ede,  M. : Ohio  State  M.  J.  50 : 837,  1954. 

5.  Bleiberg,  J.:  Am.  Practitioner  ^:1404,  1957. 


pain 


and  inflammation 

withBUFFERir 
IN  ARTHRITIS 

salicylate  benefits  with 
minimal  salicylate  drawbacks 

Rapid  and  prolonged  relief  — with  less  intoler- 
ance. The  analgesic  and  specific  anti- 
inflammatory action  of  Bufferin  helps  re- 
duce pain  and  joint  edema— comfortably. 
Bufferin  caused  no  gastric  distress  in  70 
per  cent  of  hospitalized  arthritics  with 
proved  intolerance  to  aspirin.  (Arthritics 
are  at  least  3 to  10  times  as  intolerant  to 
straight  aspirin  as  the  general  population.^) 

No  sodium  accumulation.  Because  Bufferin  is 
sodimn  free,  massive  dosage  for  prolonged 
periods  will  not  cause  sodivun  accumula- 
tion or  edema,  even  in  cardiovascular  cases. 
Each  sodium-free  Bufferin  tablet  contains  acetyl- 
salicylic  acid,  5 grains,  and  the  antacids  magnesium 
carbonate  and  aluminum  glycinate. 

Reference;  1.  J.A.M.A.  158:386  (June  4)  1955. 


Bristol-Myers  Company 

19  West  50  St.,  New  York  20,  N.  Y 


Gastric  distress  accompanying  "predni-steroid” 
therapy  is  a definite  clinical  problem  —well 
documented  in  a growing  body  of  literature. 


I'iew  of  the  beneficial  re- 
observed  when  antacids 
id  diets  were  used  concom- 
ith  prednisone  and  predni- 
ve  feel  that  these  measures 
be  employed  prophylacti- 
offset  any  gastrointestinal 
cts.” — Dordick,  J.  R.  et  al.: 
ite  J.  Med.  57:2049  (June 
7. 


H!“It  is  our  growing  convic- 
tion that  all  patients  receiving 
oral  steroids  should  take  each 
dose  after  food  or  with  ade- 
quate buffering  with  aluminum 
or  magnesium  hydroxide  prep- 
arations.”— Sigler,  J.  W.  and 
Ensign,  D.  C.:  J.  Kentucky 
State  M.  A.  54:771  (Sept.)  1956. 


5i«“The  apparent  high  inci- 
dence of  this  serious  [gastric] 
side  effect  in  patients  receiving 
prednisone  or  prednisolone 
suggests  the  advisability  of 
routine  co-administration  of  an 
aluminum  hydroxide  gel.” — 
Bollet,  A.  J.  and  Bunim,  J.  J.: 
J.  A.  M.  A.  158:459  (June  11) 
1955. 


One  way  to  make  sure  that  patients  receive 
full  benefits  of  "predni-steroid"  therapy  plus 
positive  protection  against  gastric  distress  is 
by  prescribing  co-deltra  or  co-hydeltra. 


PREDNISONE  BUFFERED 


ipie  compressed  tablets 


provide  all  the  benefits 
of  “Predni-steroid”  therapy— 
plus  positive  antacid  protection 
against  gastric  distress 


2.S  mg.  or  5.0  mg.  of  prednisone 
or  prednisolone,  plus  300  mg.  of 
dried  aluminum  hydroxide  gel 
and  50  mg.  magnesium  trisili- 
eate,  in  bottles  of  30,  100,  500. 


MERCK  SHARP  & DOHME  Division  of  MERCK  & CO..  Inc.,  Philadelphia  l.  Pa. 


58 


S.D.J.O.M.  MARCH  1958  - ADV. 


BUY 

An  old  adage  says  "Clothes  make  the  man."  Per- 
haps this  is  not  true  in  a very  strict  sense,  but 
nevertheless  a v/ell-groomed  man  makes  a better 
impression  than  one  who  is  not.  This  same  reason- 
ing may  well  apply  to  the  printed  forms  which 
leave  your  office.  A dignified,  well-printed  state- 
ment or  envelope  can  lend  a great  deal  of  prestige 
to  your  practice.  It  costs  no  more  to  get  QUALITY 
printing  than  poor  printing. 

QUALITY 
IN  YOUR 

PRINTING 

We've  had  many  years  of  printing  experience  and 
would  like  to  help  you  with  your  printing  require- 
ments. 

MIDWEST-BEACH  COMPANY 

222  South  Phillips  Ave. 

• Sioux  Falls,  S.  Dak. 

in  dysmenorrhea 


Pavatrine"^  with  Phenobarbilai 

125  mg.  IS  mg. 

• relaxes  the  hypertonic  uterus  thus,  relieving  pain 

• furnishes  gentle  sedation 

— Cv 

Dosage:  one  tablet  three  times  a day  beginning  three  to  five  days  before  onset 
of  menstruation. 


TASTY, 

FAST-ACTING 
ORAL  FORM 
OF  CITRATE-BUFFERED 
ACHROMYCIN  V 


aqueous 
ready-to-use 
freely  miscible 


• accelerated  absorption  in  the  gastro- 
intestinal tract 

• early,  high  peaks  of  concentration  in  body 
tissue  and  fluid 

• quick  control  of  a wide  variety  of  infections 

• unsurpassed,  true  broad-spectrum  action 

• minimal  side  effects 

• well-tolerated  by  patients  of  all  ages 

ACHROMYCIN  V SYRUP: 

Orange  Flavor.  Each  teaspoonful  (5  cc.) 
contains  125  mg.  of  tetracycline,  HCI  equivalent, 
citrate-buffered.  Bottles  of  2 and  16  fl.  oz. 

DOSAGE: 

6-7  mg.  per  lb.  of  body  weight  per  day. 

»Reg.  U.  S.  Pat.  Off. 


L.EDERLE  LABORATORIES  DIVISION 
AMERICAN  CYANAMID  COMPANY 
PEARL  RIVER.  NEW  YORK 


n6W  for  angina 


with  a shelter  of 
tranquility 


links 

freedom  from 
anginal  attacks 


In  pain.  Anxious.  Fearful.  On  the  road  to  cardiac 
invalidism.  These  are  the  pathways  of 
angina  patients.  For  fear  and  pain  are  inexorably 
linked  in  the  angina  syndrome. 


For  angina  patients —perhaps,  the  next  one  who 
enters  your  office— won’t  you  consider  new 
CARTRAX?  This  doubly  effective  therapy  combines 
PETN  (pentaerythritol  tetranitrate)  for  lasting 
vasodilation  and  atarax  for  peace  of  mind. 

Thus  CARTRAX  relieves  not  only  the  anginal  pain 
but  reduces  the  concomitant  anxiety. 

Dosage  and  supplied:  begin  with  1 to  2 yellow  cartrax 
“10”  tablets  (iO  mg.  petn  plus  10  mg.  atarax)  3 to  4 times 
daily.  When  indicated,  this  may  be  increased  for  more 
optimal  effect  by  switching  to  pink  cartrax  “20”  tablets 
(20  mg.  PETN  plus  10  mg.  atarax.)  For  convenience,  write 
“cartrax  10”  or  “cartrax  20.”  In  bottles  of  100. 

CARTRAX  should  be  taken  30  to  60  minutes  before  meals,  on 
a continuous  dosage  schedule.  Use  petn  preparations 
with  caution  in  glaucoma. 

“Cardiac  patients  who  show  significant  manifestations  of 
anxiety  should  receive  ataractic  treatment  as  part  of  the 
therapeutic  approach  to  the  cardiac  problem.”^ 

1.  Waldman,  S.,  and  Pelner,  L.:  Am.  Pract.  & Digest  Treat.  S:!075  (.luly)  1957. 
Division,  Chas.  Pfizer  if  Co.,  Inc.  ’trademark 


S.D.J.O.M.  MARCH  1958  - ADV. 


61 


To  cut  daytime  lethargy 
(and  keep  rauwolfia  potency) 
in  treatment  of  hypertension: 


Mounting  clinical  evidence 
confirms  the  view  that 
Harmonyl  produces  much  less 
lethargy  while  reducing  blood 
pressure  effectively.  In  the  most 
recent  study ^ Harmonyl  was 
evaluated  in  comparison  with 
reserpine  and  other  rauwolfia 
alkaloids.  Harmonyl  was  the 
only  alkaloid  which  produced  a 
hypotensive  response  closely 
matching  that  of  reserpine, 
coupled  with  a greatly  reduced 
rate  of  lethargy.  Only  one 
Harmonyl  patient  in  20 
showed  lethargy,  while  an 
average  of  11  out  of  20  showed 
lethargy  with  reserpine,  and  10 
out  of  20  with  the  r\()() 
alseroxylon  fraction.  Lujumt 


802077 


for  your  hypertensives  who  must  stay  on  the  job 

Harmonyl 

(deserpidine,  ab8ott) 

while  the  drug  works  effectively  . . . so  does  the  patient 


1.  Comparative  Effecls  of  Various 
Rauwolfia  Alkaloids  in  Hypertension; 
Diseases  of  the  Chest:  in  press. 


NO  WAITIN; 


in  anxiety  and  hypertension 


NEW  fast-acting 


®’Harmonyl-N' 

(Harmonyl*  and  Nembutal'^)) 

Calmer  days,  more  restful  nights  starting  first  day 
of  treatment,  through  synergistic  action  of 
Harmonyl  (Deserpidine,  Abbott)  and  Nembutal 
(Pentobarbital,  Abbott).  Lower  therapeutic 
doses,  lower  incidence  of  side  effects.  Each 
Harmonyl-N  Filmtab  contains  30  mg.  Nembutal 
Calcium  and  0.25  mg.  Harmonyl.  Each 
Harmonyl-N  Half-Strength  Filmtab  combines 
15  mg.  Nembutal  Calcium  and 
0.1  mg.  Harmonyl.  OMott 


In  a semi-fluid  stnte-it’s  quickly 
absorbed  and  well  tolerated 


Hematovals  therapy  for  refractory  hypochro 
mic  anemia  provides  semi-fluid  iron  in  a soft 
elastic  capsule  for  rapid  absorption  withou 
gastric  irritation. 

Each  capsule  supplies  58  mg.  of  ferrous  ionii 
iron.  Normal  blood  levels  are  quickly  restored 
Achlorhydria  does  not  compHcate  Hematoval 
therapy  because  the  iron  remains  in  the  ferrou 
state  during  conversion. 

The  cobalt  factor  induces  better  hemoglobi! 
synthesis  and  quicker  response.  Hematovals  als' 
contain  vitamin  B12,  folic  acid,  liver  and  B-com 
plex  factors  to  help  overcome  anorexia.  Assimila 
tion  is  assisted  by  the  ascorbic  acid  present  i 
each  Hematoval.  i 


iACH  CAPSULE  CONTAINS: 

Ferrous  Sulfate,  4.5  gr. 


Iron 58  mg. 

Cobalt  Sulfate  2.0  mg. 

Cobalt 0.4  mg. 

Liver,  Desiccated,  N.F 110  mg. 

Vitamin  Bu 1 meg. 


Folic  Acid 0.25  mg. 

Thiamine  Mononitrate 1 mg. 

Riboflavin 1 mg. 

Pyridoxine  Hydrochloride. 0.25  mg. 
Calcium  Pantothenate. . . .0.25  mg. 

Nicotinamide 3.3  mg. 

Ascorbic  Acid 16.66  mg. 


Hematovals® 


THE  ULMER  PHARMACAL  COMPAN 


1 400  HARMON  PLACE,  MINNEAPOLIS  3,  MINNESOTA 


0Filmtab— Film-sealed  tablets,  Abbott;  pat.  applied  for 
601060  *Tradem3rk 


S.D.J.O.M.  MARCH  1958  - ADV. 


63 


When  anxiety  and  tension  "erupts”  in  the  G.  I.  tract. . . 


in  spastic 

and  irritabie  colon 


PATH  I BAM  ATE 

Meprobamate  with  PATH  I LON®  Lederle 


Combines  Meprobamat©  {400  mg.)  the  most  widely  prescribed  tranquilizer...  helps  control  the 
“emotional  overlay”  of  spastic  and  irritable  colon — without  fear  of  barbiturate  loginess,  hangover  or 
habituation  . . . with  PATHILON  (25  mg.)  the  anticholinergic  noted  for  its  extremely  low  toxicity 
and  high  effectiveness  in  the  treatment  of  many  G.I.  disorders. 

Dosage:  1 tablet  t.i.d.  at  mealtime.  2 tablets  at  bedtime.  Supplied:  Bottles  of  100,  1,000. 

^Trademark  ® Registered  Trademark  for  Tridihexethyl  Iodide  Lederle 

LEDERLE  LABORATORIES  DIVISION,  AMERICAN  CYANAMID  COMPANY,  PEARL  RIVER.  NEW  YORK 


there’s  pain  and 
inflammation  here... 
it  could  be  mild 
or  severe,  acute 
or  chronic,  primary 
or  secondary 
fibrositis— or  even 
early  rheumatoid 
arthritis 


more  potent  and 
comprehensive 
treatment  than 
salicylate  alone 

. . . assured  anti-inflammatory 
effect  of  low-dosage 
corticosteroid' 

. . . additive  antirheumatic 
action  of  corticosteroid 
plus  salicylate^"^  brings 
rapid  pain  relief;  aids 
restoration  of  function. 


. . . wide  range  of  appIicatiO: 
including  the  entire 
fibrositis  syndrome 
as  well  as  early  or  mild  ■ 
rheumatoid  arthritis 

more  manageable 
corticosteroid  dosage 

. . . much  less  likelihood 
of  treatment-interruptin 
side  effects'  * 

. . . simple,  flexible  ’ 

dosage  schedule  j 


Jte  conditions:  Two  or  three 
lets  four  times  daily.  After 
ured  response  is  obtained, 
dually  reduce  daily  dosage 
J then  discontinue, 
tiacute  or  chronic  conditions: 
tially  as  above.  When  satisfactory 
itrol  is  obtained,  gradually  reduce 
1 daily  dosage  to  minimum 
active  maintenance  level.  For  best 
.ults  administer  after  meals  and 
bedtime. 

icautions:  Because  sighagen 
itains  prednisone,  the 
me  precautions  and 
ntraindications  observed 
th  this  steroid  apply  also 
the  use  of  sigmagen. 


Composition 

Meticorten®  (prednisone)  0.75  mg. 

Acetylsalicylic  acid  325  mg. 

Aluminum  hydroxide  75  mg. 

Ascorbic  acid  20  mg. 

Packaging:  Sigmagen  Tablets,  bottles  of  100  and  1000. 
References:  1.  Spies,  T.  D.,  et  al.:  J.A.M.A.  159:645, 
1955.  2.  Spies,  T.  D.,  et  al.:  Postgrad.  Med.  17:1,  1955. 
3.  Gelli,  G.,  and  Della  Santa,  L.:  Minerva  Pediat. 
7:1456,  1955.  4.  Guerra,  F.:  Fed.  Proc.  12:326,  1953. 
5.  Busse,  E.  A.:  Clin.  Med.  2:1105,  1955.  6.  Sticker, 
R.  B.:  Panel  Discussion,  Ohio  State  M.  J.  52:1037, 1956. 


SCHERING  CORPORATION  • BLOOMFIELD,  N.  J. 


in  any  case 
it  calls  for 


:orticojd-salicyiate  compound 


tablets 


FROM  INFECTION- 


FROM  IRRITATION 


*as  adjunctive  therapy  only 


THE  FIRST  TROCHE  TO  PROVlOE 
THREEFOLD  RENEFITS 


NON-NARCOTIC  ANTITUSSIVE  EFFICACY 
SHOWN  TO  APPROXIMATE  THAT  OF  CODEINE 


With  the  addition  of  a non-narcotic  antitussive 
to  troche  medication,  Tentazets’  provides 
a new  and  extended  therapeutic  advantage  in 
this  convenient  form  of  treatment. 

Treatment  of  the  cough  too,  so  often  a 
troublesome  symptom  of  sore  throat,  combined 
with  wide-range  antibiotic  activity  and 
soothing  analgesic  benefit,  now  offers  threefold 
relief  in  a variety  of  throat  irritations. 

And  Tentazets’  are  pleasant-tasting,  too, 
making  them  highly  acceptable,  especially 
to  children. 

<PENTAZETS’  contains: 

• Homarylamim—a  new  non-narcotic  antitussive  with  cough 
control  shown  to  approximate  that  of  codeine.  • Bacitracin- 
Tyrothricin-Neomycin  — a.  combined  antibiotic  treatment 
against  many  pathogenic  organisms  with  little  danger  of 
unfavorable  side  effects.  • Benzocaine—a  local  anesthetic  for 
soothing  relief  to  inflamed  tissues.  Being  slowly  absorbed, 
it  is  especially  beneficial  for  prolonged  effect  and  benefit  to 
surrounding  areas.. 

Supplied;  Vials  of  12. 

Each'PENTAZETS'  troche  contains: 


Homarylamine  hydrochloride  20  mg. 

Zinc  Bacitracin 60  units 

Tyrothricin , Img. 

Neomycin  sulfate  6 mg. 

(equivalent  to  3.6  mg.  neomycin  base) 
Benzocaine 6 mg. 


MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  & CO.,  Inc.,  PHILADELPHIA  1,  PA 


68 


S.D.J.O.M.  MARCH  1958  - ADV. 


Protection  against  loss  of  income  from  acci- 
dent & sickness  as  well  as  hospital  expense 
benefits  for  you  and  all  your  eligible  depend- 
ents. 


All 


COME  FROM 


PHYSICIANS 

SURGEONS 

DENTISTS 


All 


60  TO 


PHYSICIANS  CASUALTY  & HEALTH 
ASSOCIATIONS 

OMAHA  31,  NEBRASKA 
SINCE  1902 


ANNUAL  MEETING  SPEAKERS 
SELECTED 

All  of  the  annual  meeting  speakers  have 
been  selected  for  appearances  May  19-20  in 
Huron,  it  was  announced  by  Dr.  M.  M.  Mor- 
rissey, association  president. 

On  the  program  will  be: 

Charles  Schneider,  M.D. 

Dearborn,  Mich. 

John  A.  Rauie,  Ph.D. 

Kansas  City,  Mo. 

Ormond  S.  Culp,  M.D. 

Rochester,  Minn. 

John  S.  Wech,  M.D. 

Rochester,  Minn. 

Thomas  J.  O’Neill,  M.D.  ^ 

Philadelphia,  Pa.  ' 

R.  V.  Platou,  M.D. 

New  Orleans,  La.  , 

Franz  Altmann,  M.D.  } 

New  York  City,  N.  Y. 

Milton  Friedman,  M.D. 

New  York  City,  N.  Y.  | 

Benjamin  M.  Gasul,  M.D. 

Chicago,  111. 

Paul  Winchell,  M.D. 

Minneapolis,  Minn. 

Richard  G.  Lester,  M.D. 

Minneapolis,  Minn. 


VMS -200 


'Premarin''  with  Meprobamate  new  potency 

Each  tablet  contains  0.4  mg.  "Premarin,"  200  mg.  meprobamate 

For  undue  emotional  stress 
in  the  menopause 

WRITE  SIMPLY... 


Also  available  as 

PMB-400  (0.4  mg.  "Premarin,"  400  mg.  meprobamate 
in  each  tablet). 


Supply: 

No.  880,  PMB-200 
bottles  of  60  and  500. 

No.  881,  PMB-400 
bottles  of  60  and  JOO. 


AYERST  LABORATORIES 


New  York  16,  New  York 


Montreal,  Canada 


6830 


’'Premarin®*'  con|ugated  estrogens  (equine) 


Meprobamate  licensed  under  U.S.  Pat.  No.  2,724,720 


what  are  the  7 “dont’s” 

of  office  psychotherapy? 

(!)  Don’t  argue~let  patient  “talk  out”  his  troubles.  (2)  Don’t  counsel-help 
him  solve  his  own  problems.  (3)  Don’t  be  hostile— allow  patient  to  express 
hostility  without  reciprocating.  (4)  Don’t  be  unsure  — stress  significance  of 
normal  or  abnormal  physical  findings  in  relation  to  symptoms.  (5)  Don’t  be 
too  reassuring— overoptimism  may  suggest  you  take  the  symptoms  too 
lightly.  (6)  Don’t  approve  or  censure.  (7)  Don’t  be  too  credulous— patients’ 
words  may  conceal  hidden  meanings. 

Source  ~ Hyman,  M.:  Some  Aspects  of  Psychiatry  in  General  Practice,  GP  76:83 
(Oct.)  1957. 

calmative  NOSTYI* 

Ectylurea,  Ames 
(2-ethyl-cu-crotonylurea) 

jor  tranquil— not  “tranquilized”  patients 

“Anxiety  and  nervous  tension  states  appeared  to  be  most  benefited. . . .The  patients 
experienced  and  expressed  a feeling  of  greater  inward  security,  serenity. ...Mental 
depression,  one  of  the  undesirable  side  actions  in  many  other  sedatives,  did  not 
develop  in  any  of  the  patients 

*Bauer,  H.  G.;  Seegers,  W;  Krawzoff,  M.,  and  McGavack,  T.  H.;  A Clinical  Evaluation 
of  Ectylurea  (Nostyn®),  in  press. 

dosage:  Children— ISO  mg.  (Vi  tablet)  three  or  four  times  daily.  Adults— 150-300 
mg.  (Vi  to  1 tablet)  three  or  four  times  daily. 

supplied:  300  mg.  scored  tablets;  bottles  of  48  and  500. 


AMES  COMPANY,  INC  • ELKHART,  INDIANA 
Ames  Company  of  Canada,  Ltd.,  Toronto  44258 


in  G.l.  disorders 

Xompazine’  controls  tension 
—often  brings  complete  relief 

In  such  conditions  as  gastritis,  pylor- 
ospasm,  peptic  ulcer  and  spastic 
colitis,  ‘Compazine’  not  only  re- 
lieves anxiety  and  tension,  but  also 
controls  the  nausea  and  vomiting 
\vhich  often  complicate  these 
disorders. 

Physicians  who  have  used  ‘Com- 
pazine’ in  gastrointestinal  disorders 
— often  in  chronic,  unresponsive 
cases — have  had  gratifying  results 
(87%  favorable). 

Compazine 

the  tranquilizer  and  antiemetic 
remarkable  for  its  freedom  from 
drowsiness  and  depressing  effect 

Available:  Tablets,  Ampuls,  Multi- 
ple dose  vials,  Spansule®  sustained 
release  capsules.  Syrup  and  Sup- 
positories. 

*T.M.  Reg.  U.S.  Pat.  OfiF.  for  prochlorperazine,  S.K.F. 


Smith  Kline  & French  Laboratories,  Philadelphia 


APRIL  ir  1958 


QUALITY  / HESf  AHCK  / iNTiGRlTY 


Antacid  therapy  in  the  bes 


LIQUID 


(Magnesium  Trisilicate  and  Colloidal  Aluminum  Hydroxide,  Lilly) 


Combines  palatability  with  effecti 


In  12-ounce  bottles  at  pharmacies 


EL!  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.  S 


' harmaceutical  Convention— Brookings— June  22,  23, 24, 25 


ORAL 


progestational  agent 
with 

unexcelled  potency 
and 

unsurpassed  efficacy 


in  functional  uterine  bleeding 

Functional  uterine-bleeding  is  usually  due 
to  failure  of  ovulation  "with  sustained  estrogenic 
stimulation  of  the  endometr  ium  in  the  absence 
of  progesterone.  The  most  effective  type 
of  hormone  in  arresting  a bout  of  functional  uterine 
bleeding  is  a progestational  agentd  Administered 
orally,  NORLUTIN  produces  presecretory  to  secretory 
and  marked  progestational  endometrium  in 
3 to  14  days.^"®  The  return  of  normal  menstruation 
frequently  can  be  induced  by  continued  cyclic 
therapy  with  NORLUTIN  during  successive  months. 

case  summary 

A 44-year-old  woman  had  spotting  and  bleeding 
for  10  days.  She  was  treated  with  NORLUTIN, 

10  mg.  twice  daily  for  4 days.  Bleeding  stopped 
during  medication  and  24  to  72  hours  after 
cessation  of  therapy  normal  withdrawal 
bleeding  occurred. 

References:  (1)  Greenblatt,  R.  B.,  & Clark,  S.  L.: 

M.  CIiB.  North  America,  Philadelphia, 

W.  B.,  Saunders  Company  (Mar.)  1957,  p.  587. 

(2}  Creenblatt,  R.  B. ; Clin.  Endocrinol. 

16:869, 1956.  (S)  Hertz,  R.;  Waite,  J.  H., 

& Thomas,  L-  B.:  Proc.  Soc.  Exper.  Biol,  ir  Med. 

9I;418, 1956. 


TM. 


(norethindrone,  Parke-Davis) 

IMDiCATlONS  FOR  NORLUTIN:  conditions  involving  deficiency 
of  progesterone  such  as  primary  and  secondary  amenorrhea, 
menstrual  irregularity,  functional  uterine  bleeding, 
endocrine  infertility,  habitual  abortion,  threatened  abortion, 
premenstrual  tension,  and  dysmenorrhea. 

RACK  AGING:  5-mg.  Scored  tablets  (C.  T.  No.  882),  bottles  of  30. 


N RLUTIN 


PARKE,  DAVIS  & COMPANY  • DETROIT  32.  MICHIGAN 


THE  SOUTH  DAKOTA 


JOURNAL  OF  MEDICINE 

AND 


PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


Volume  XI 


April  1958 


Number  4 


CONTENTS 


MEDICAL  SECTION 

Selective  Pituitary  Failure 127 

Gordon  S.  Paulson,  M.D.  and  Nathaniel  R.  Whitney,  M.D., 

Rapid  City,  South  Dakota 

B.  A.  Bobb,  M.D.,  1871-1958  132 

Recent  Advances  In  Cardiac  Surgery 133 

Dwight  C.  McGoon,  M.D.,  Rochester,  Minnesota 

Obesity  In  Children 139 

Lee  Forrest  Hill,  M.D.,  Des  Moines,  Iowa 

Congressional  Candidates  Have  Their  Say 144 

President’s  Page 146 

M.  M.  Morrissey,  M.D.,  Pierre,  South  Dakota 

Medical  Economics  Page 147 

Editorial  Page 149 

Medical  Library  Bookshelf 151 

This  is  Your  Medical  Association  . 154 

PHARMACY  SECTION 

Legal  Requirements  For  Rx  Departments  156 

W.  E.  Powers,  New  York,  New  York 

The  Prescription  Pharmacist  Today 162 

Wallace  Croatman  and  Paul  B.  Sheatsley,  New  York  City,  N.  Y. 

Pharmaceutical  Economics  Page 165 

President’s  Page 167 

George  Lehr,  Rapid  City,  South  Dakota 

Editorial  Page 168 

Pharmacy  News 170 


Entered  as  second-class  matter  January  22,  1948  at  the  post  office  at  Sioux  Falls,  South  Dakota 

under  the  act  of  August  24,  1912 

Published  monthly  by  the  South  Dakota  Medical  Association,  Publication  Office 
300  First  National  Bank  Building,  Sioux  Falls,  South  Dakota 


S.D.J.O.M.  APRIL  1958  - ADV. 


3 


a unique  new  medical  communications  service —produced  by  the 
Medical  Education  Department,  Lakeside  Laboratories,  Inc. 

Significant  scientific  exhibits  at  medical  meetings  throughout  the  nation 
will  be  preserved  on  film ...  permanently  available  for  study  by  the 
thousands  of  physicians  anxious  to  keep  up  with  the  newest  develop- 
ments in  medicine  and  surgery. 

These  filmstrips,  together  with  recorded  commentaries,  will  be  given 
on  request  to  Medical  Schools,  County,  State  and  Sectional  Medical 
Societies,  not  as  a loan  but  as  a permanent  contribution. 


ready  now  for  distribution 

Six  widely  acclaimed  scientific  exhibits  selected  from  those  at  the  106th  Annual 
Meeting,  American  Medical  Association,  New  York,  June  3-7,  1957. 

FILMSTRIP  1 Parti  The  Present  Indications  for  Cardiac  Surgery  • 
Robert  P Glover,  Julio  C.  Davila  and  Robert  G.  Trout  (Philadelphia)  • Billings  Gold 
Medal  for  excellence  in  the  correlation  and  presentation  of  facts  . Part  II  Oral 
Organomercurial  Diuretics  • Sim  E Dimitroff  and  George  C.  Griffith  (Los  Angeles) 

FILMSTRIP  2 Part  I The  Hands  in  Arthritis  and  Related  Conditions  • 
Darrell  C.  Crain  (Washington,  D.  C.)  • Certificate  of  Merit  • Part  II  Intra- 
muscular Iron  for  the  Treatment  of  Iron  Deficiency  Anemia  in  Infancy  • Ralph  O. 
Wallerstein,  and  M.  Silvija  Hoag  (San  Francisco) 

FILM  STRIP  3 Part  I Bronchial  Asthma  • John  W.  Irwin,  Irving  H.  Itkin, 
Sandylee  Weille  and  Nancy  Little  (Boston)  • Honorable  Mention  Award  • Part  II 
The  Direct  (Open)  Surgical  Repair  of  Congenital  and  Acquired  Intracardiac  Mal- 
formations • C.  W.  Lillehei,  H.  E.  Warden,  R.  A.  DeWall,  V L.  Gott,  R.  D.  Sellers, 
M.  Cohen,  R.  C.  Read,  R.  L.  Varco  and  O.  H.  Wangensteen  (Minneapolis)  • Hektoen 
Gold  Medal  for  originality  and  excellence  of  presentation  in  an  exhibit  of  original 
investigation 


Officers  of  Medical  Societies  and  Medical  School  libraries  wishing  to  start  their 
library  of  Filmstrips  of  Scientific  Exhibits  now,  should  address  their  requests  to: 
EXHIBITS-ON-FILM,  Medical  Education  Department,  Lakeside  Laboratories, 
Inc.,  Milwaukee  1,  Wisconsin 

Individual  physicians  who  wish  to  arrange  showings  such  as  at  hospital  staff  meetings 
should  contact  the  secretary  of  their  Medical  Society  or  Medical  School  librarian. 


THE  SOUTH  DAKOTA 


JOURNAL  OF  MEDICINE 

AND 


PHARMACY 

JOURNAL  OF  THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION. 
THE  SOUTH  DAKOTA  PHARMACEUTICAL  ASSOCIATION  AND 
THE  SIOUX  VALLEY  MEDICAL  ASSOCIATION 


SUBSCRIPTION  $2.00  PER  YEAR 


SINGLE  COPY  20c 


Volume  XI 


April  1958 


Number  4 


STAFF 

Acting  Editor Robert  Van  Demark,  M.D. Sioux  Falls,  S.  D. 

Assistant  Editor Patricia  Lynch  Saunders Sioux  Falls,  S.  D. 

Associate  Editor Harold  S.  Bailey,  Ph.D — Brookings,  S.  D. 

Associate  Editor D.  L.  Kegaries,  M.D. Rapid  City,  S.  D. 

Associate  Editor J.  A.  Nelson,  M.D. Sioux  Falls,  S.  D. 

Associate  Editor D.  H.  Manning,  M.D Sioux  Falls,  S.  D. 

Business  Manager — John  C.  Foster Sioux  Falls,  S.  D. 

EDITORIAL  COMMITTEE 

G.  S.  Paulson,  M.D Rapid  City,  S.  D. 

M.  U.  Spain,  M.D Rapid  City,  S.  D. 

H.  R.  Wold,  M.D Madison,  S.  D. 

Mary  Price,  M.D. Armour,  S.  D. 

Harold  Lowe,  M.D. Mobridge,  S.  D. 

A.  C.  Michael,  M.D. Vermillion,  S.  D. 

T.  W.  ReuI,  M.D. Watertown,  S.  D. 

R.  E.  Van  Demark,  M.D. Sioux  Falls,  S.  D. 


PUBLICATIONS  COMMITTEE 

T.  H.  Saltier.  M.D..  R.  E.  Van  Demark.  M.D.  and  the  Executive  Committee  of  The  South  Dakota 
Pharmaceutical  Association. 


OFFICERS 


South  Dakota  Pharmaceutical 

Association 

D. 

D. 

Second  Vice-President 

Ah(irri<>^nr  S. 

D. 

Third  Vice«President  — 

Piftrrftj  S. 

D. 

Fourth  Vicft-PrfiRlriftnt 

ParkfiPf  S. 

D. 

.1.  r.  J^hirlpy 

D. 

Secretary  .. 

Bliss  C.  Wilson 

Pierre,  S. 

□, 

South  Dakota  State  Medical  Association 

Prft.«?iriftnt  * 

President  Elect  . 

Hiiron^  S.  D 

Secretary-Treasurer - 

A.  P.  Redina.  M.D. 

Alternate  Delegate  to  A.M.A. 

A.  P.  Redinq,  M.D. 

Speaker  of  The  House 

n.  R.  Stoltz,  M.D. 

Sioux  Valley  Medical  Association 

President  . . . 

A.  P.  Redina.  M.D.. 

Marion.  S.  D. 

Vice-President R.  P.  Carroll,  M.D Laurel,  Nebr. 

Secretary Edward  Sibley,  M.D Sioux  City,  Iowa 

Treasurer.. A.  K.  Myrabo,  M.D Sioux  Falls,  S.  D. 


S.D.J.O.M.  APRIL  1958  - ADV. 


5 


IN  ALL  DIARRHEAS . . . REGARDLESS  OF  ETIOLOGY 


comprehensive  control 

with 


CREMOMYCIN 

eulfasuxidineI  pectin. kaolin-neomycin  suspension 


SOOTHING  ACTION . . . Kaolin  and  pectin  coat  and  soothe  the  inflamed  mucosa,  ad- 
sorb toxins  and  help  reduce  intestinal  hypermotility. 

BROAD  THERAPY . . . The  combined  antibacterial  effectiveness  of  neomycin  and 
Sulfasuxidine  is  concentrated  in  the  bowel  since  the  absorption  of  both  agents 
is  negligible. 

LOCAL  IRRITATION  IS  REDUCED  and  control  is  instituted  against  spread  of  infective 
organisms  and  loss  of  body  fluid. 


PALATABLE  creamy  pink,  fruit-flavored  cremomycin  is  pleasant  tasting,  readily 
accepted  by  patients  of  all  ages. 

* Sulfasuxidine  is  a trade-mark  of  Merck  & Co.,  Inc. 


MERCK  SHARP  & DOHME 

DIVISION  OF  MERCK  & CO.,  Inc.,  PHIUDELPHIA  1,  PA. 


;it;ir;ix 

in  any 

hyperemotive 

state 

for  chfidiiood  behavior  disorders 

10  mg.  tablets— 3-6  years,  one  tab- 
let t.i.d.;  over  6 years,  tvvo  tablets 
t.i.d.  Syrup— 3-6  years,  one  tsp. 
t.i.d.j  over  6 years,  two  tsp.  t.i.d. 

for  adult  tension  and  anxiety 

25  mg.  tablets— one  tablet  q.i.d. 
Syrup-one  tbsp.  q.i.d. 

for  severe  emotional  disturbances 

100  mg.  tablets— one  tablet  t.i.d. 

for  adult  psychiatric  and  emotional 
emergencies 

Parenteral  Solution— 25-50  mg. 
{1-2  cc.)  intramuscularly,  3-4 
times  daily,  at  4-hour  intervals. 
Dosage  for  children  under  12  not 
established. 

Supplied:  Tablets,  bottles  of  100.  Syrup, 
pint  bottles.  Parenteral  Solution,  10  cc. 
muttiple-dose  vials. 


The  psychological  needs  of  the  elderly  confront  physicians  with  one  of  their  most 
perplexing  problems.  Perhaps  no  other  patient  group  suffers,  so  much  from  emo- 
tional distress.  Yet,  precisely  because  of  their  age,  geriatric  patients  often  seem 
beyond  the  reach  of  tranquilizing  treatment. 

When  tranquilization  seems  risky  . . . 

They  are  too  much  beset  by  complicating  chronic  ailments,  too  susceptible  to 
serious  side  effects.  Ataraxia  is  clearly  indicated,  yet  the  doctor  cannot  risk  side 
reactions  on  liver,  blood  or  nervous  system. 

Is  there  an  answer  to  this  dilemma? 

We  feel  there  is.  In  four  recent  papers  investigators  have  reported  good  results  with 
ATARAX  in  patients  up  to  90  years  of  age.*  In  one  study,  improvement  was  “pro- 
nounced” in  76%,  “good”  in  an  additional  18.5%.*  ATARAX  has  been  successfully 
used  in  such  cases  as  senile  anxiety,  agitation,  hyperemotivity  and  persecution 
complex.*  On  ATARAX,  patients  became  . . quieter  and  more  manageable.  They 
slept  better  and  demonstrated  improved  relations  with  other  patients  and  hospital 
personnel.  Even  their  personal  hygiene  improved,  and  they  required  less  super- 
visory management.”* 

. . . ATARAX  Is  safe 

Yet  even  in  the  aged,  ATARAX  has  given  "no  evidence  of  toxicity. Complete  liver 

function  tests  and  blood  studies  were  made  on  all  patients  after  two  months  of 
therapy.  . . . There  were  no  significant  abnormalities.”*  With  still  other  elderly 
patients  “tolerance  to  the  drug  was  excellent,  even  in  cases  where  the  patients 
were  given  relatively  high  doses.”*  Similarly,  no  parkinsonian  effects  have  been  ob- 
served on  ATARAX  therapy. 

Nor  does  ATARAX  make  your  patients  want  to  sleep  all  day.  Instead,  they  can  better 
take  care  of  themselves,  because  atarax  leaves  them  both  calm  and  alert.  In  sum, 
ATARAX  . . does  not  impair  psychic  function  and  has  a minimum  of  side  effects. 
...  It  appears  that  ATARAX  is  a safe  drug ”* 

These,  undoubtedly,  are  the  results  you  want  when  emotional  problems  beset  your 
geriatric  patients.  For  the  next  four  weeks,  won’t  you  prescribe  tiny  atarax  tablets 
or  pleasant-tasting  ATARAX  syrup -both  so  readily  acceptable  to  the  elderly. 

(BRAND  OF  HYDROXYZINE) 


Medical  Birector 


S.D.J.O.M.  APRIL  1958  - ADV. 


7 


SYNTHETIC  BILIARY  ABSTERGENT 


ZANCHOE 

(brand  of  florantyrone) 

Fills  an  Important  Postcholecystectomy  Need 


The  excellent  results  with  Zanchol  in  pa- 
tients whose  gallbladders  have  been  re- 
moved have  been  most  pronounced  in  two 
phases  of  management: 

1.  Early— Zanchol  in  Postoperative  Care. 
T-tube  studies  have  demonstrated  that 
Zanchol  increases  the  volume  and  fluidity 
of  bile,  at  the  same  time  changing  its  color 
to  a clear,  brilliant  green.  The  greatly  im- 
proved abstergent  cleansing  action  of  the 
bile  is  noted  in  its  ability  to  keep  the  T 
tubes  clean’^  without  rinsing  in  most  cases. 

2.  Late— Zanchol  in  Postcholecystectomy 
Syndrome.  By  improving  the  physico- 
chemical properties  of  bile  and  increasing 


its  flow,  Zanchol  acts  to  eliminate  biliary 
stasis  and  sharply  reduce  or  eliminate  bil- 
iary sediment.  The  drug  may  be  employed 
in  both  prophylaxis  and  therapy  of  the  post- 
cholecystectomy syndrome. 

Medical  Indication  for  Zanchol 

This  includes  the  treatment  of  patients 
with  chronic  cholecystitis  for  which  sur- 
gery is  not  required  or  may  be  impossible 
for  any  reason. 

Dosage : one  tablet  three  or  four  times 
daily.  Tablets  of  250  mg.  each. 

G.  D.  Searle  & Co.,  Chicago  80,  Illinois. 
Research  in  the  Service  of  Medicine. 


photomicfographs^ 

showing  daily  changes  in 
sediment  from  centrifuged  bile 
taken  from  T-tube  drainage  in 
a fiostcbolecystectomizect  ipatient. 


1.  McGowan,  J.  M.:  Clinical  Significance  of  Changes  in 
Common  Duct  Bile  Resulting  from  a New  Synthetic 
Choleretic,  Surg.,  Gynec.  & Obst.  lOi.163  (Aug.)  1956. 


s 


Remarkably 

effective 


SHje 


MARKEDLY 


Write  for  Booklet 


lAlOIAtOtIft 

Nfw  TOW  14  N » 


DOSE:  Initial  - 400  to  600  mg.  (2  or  3 tablets)  Plaquenil  sulfate  dailyr 
Maintenance  — 200  to  400  mg.  (1  or  2 tablets)  daily. 


SUPPLIED:  Tablets  of  200  mg.,  bottles  of  100. 


UFERENCES; 


i.  Seherbe],  A.X...  Schuchter,  S.li.,  B.r\d  Harrison,  J.W.:  Cleveland  Clin,  Quart,  24:08,  Apr.,  1957. 

I,  Schoch,  A.G.,  and  Alexander,  L.J.:  The  Schoch  section.  Bull,  A,  Mil,  Dermatologiate  6:25,  Nov.,  1966. 
3.  Combleet,  Theodore:  Arch.  Dermet.  78:672,  June,  1966. 


Atabrine  (brand  of  quinacrine) . Aralen  (brand  of  ( 
and  Plaquenil  ( brand  of  hydroxy 
trademarks  r«.  1_ 


. . . the  least  toxic  of  its  class . . 


CH, 

I 

NHCHCH,{CH,),N(CH,CH3), 


2HCI-2H,0 


CH, 

1 

CH-CH,  CH,  CH,  N(C 


ARALEN 

PHOSPHATE 


HOCH  CH  —N CH, 

I I 


CH,0 


QUININE 


CH— CHCH=CH 


\A 


has  a high  degree  of  clinicQ 
safety. . . It  is  considered 
to  be  the  preferred  antimalarial 
drug  for  treatment  of  disordef 
of  connective  tissue,  because 
of  the  low  incidence  of  gastrointesti 
distress  as  compared  to  that 

with  chloroquine  phosphate/^’ 


. . . Plaquenil  is  decidedly  less  toxic  and  better 
tolerated  by  the  average  patient,  even  in  hi< 
dosage,  than  is  chloroquine/'^ 


S.DJ.O.M.  APRIL  1958  - ADV. 


9 


S&iheoL 


QUecct 


'Smo/Mi  Sjo&tQaSacL 


Your  patient  has  a wide  choice  of 
unseasoned,  strained  or  chopped  foods 

The  Low 
Residue  Diet 

Consomme  can  be  served  jellied  or  hot.  Pureed 
vegetables  folded  into  well-beaten  egg  can  be 
baked  to  a puff.  Chopped  beef  moistened  with 
broth  and  mixed  with  bread  crumbs  shapes  into 
patties.  Eggs  can  be  soft  or  hard-cooked  by 
simmering.  Flaked  fish  in  lemon  gelatin  looks 
true  to  nature  when  your  patient  uses  a mold. 

For  banana-spht  salad  he  can  try  cottage 


— and  may  we 
remind  you  that 
m I a glass  of  beer 
can  make  low- 
residue  diets  more 
palatable? 


cheese  on  banana  and  top  with  pureed  apricots. 
Rice  cooked  in  pineapple  juice,  water  and  sugar 
makes  a golden  dessert.  For  a parfait,  try  layers 
of  farina  pudding  and  pureed  plums. 

Of  course,  you’U  tell  your  patient  just  which 
foods  you  want  him  to  have — and  whether  he 
can  enjoy  a glass  of  beer*  with  his  meals. 

*pH — 4.3,  104  Calories/8  oz,  glass  (Average  of  Americon  Beers) 


United  States  Brewers  Foundation 

Beer — America’s  Beverage  of  Moderation 
If  you'd  like  reprints  of  this  and  1 1 other  diets,  please  write  United  States  Brewers  Foundation,  535  Fifth  Avenue,  New  York  17,  N.  Y, 


PATHIE 


•Trademark 


calms  te, 


12 


S.D.J.O.M.  APRIL  1958  - ADV. 


Medrol 

the  corticosteroid  that  hits  the  disease, 

but  spares  the  patient 


*TRADCM«RK  FOR  METHYIPREONISOI.ONE.  UPJOHN 


The  Upjohn  Company 
Kalamazoo,  Michigan 


S.D.J.O.M.  APRIL  1958  - ADV. 


DIABETES  FOLLOWING  TRANSIENT  GLYCOSURIA=<= 


Non-Diabetic 
65  patients 
(52%) 


should  a non- diabetic, 

transient  glycosuria  ever  be 
considered  unimportant? 


Never.  A patient  showing  even  a mild  transient  glycosuria  should 
be  observed  for  years  as  a diabetic  suspect.* 

Ultimate  diagnosis  on  126  patients  with  a previous  transient  mild 
glycosuria.  Twenty  diabetics  were  discovered  5-10  years  after  a 
recorded  glycosuria— 10  diabetics  after  more  than  10  years.* 
*Murphy,  R.:  Connecticut  M.  J.  27:306,  1957. 


COLOR  CALIBRATED  CLINITESTSe=sen.Tab...s 

BRAND 

the  STANDARDIZED  urine-sugar  test 
for  reliable  quantitative  estimations 


• full  color  calibration,  clear-cut  color  changes 

• established  “plus”  system  covers  entire  critical  range 

• standard  blue-to-orange  spectrum  long  familiar  to  diabetics 

• unvarying,  laboratory-controlled  color  scale 


AMES  COMPANY,  INC  • ELKHART,  INDIANA 
Ames  Company  of  Canada,  Ltd.,  Toronto  45457 


•'Rheumatoid  arthritis  is  a constitutional  disease  with  symptoms  affecting  chiefly  joints  and  muscles. Pain 

in  the  affected  joint  is  accompanied  by  splinting  of  the  adjacent  muscles,  with  resultant  ‘muscle  spasm.’ 


MEPROLONE  Is  the  only  anti- 
rheumatic-antiarthritic  designed  to 
relieve  simultaneously  (a)  muscle 
spasm  (b)  joint-muscle  inflammation 
(c)  physical  distress ...  and  may 
thereby  help  prevent  deformity  and 
disability  in  more  arthritic  patients 
to  a greater  degree  than  ever  before. 

SUPPLIED:  Multiple  Compressed 
Tablets  in  two  formulas: 
MEPROLONE-2-2.0  mg. 
prednisolone,  200  mg.  meprobamate 
and  200  mg.  dried  aluminum 
hydroxide  gel  (bottles  of  100). 
MEPROLONE-1— supplies  1.0  mg. 
prednisolone  in  the  same  formula  as 
MEPROLONE-2  (bottles  of  100). 

1.  Comroe's  Arthritis;  Hollander,  J.  L,  p.  149  (Fifth 
Edition,  Lea  & Febiger,  Philadelphia,  Pa.  1953). 

2.  Merck  Manual:  Lyght,  C.  E.,  p.  1102  (Ninth 
Edition,  Merck  & Co.,  Inc.,  Rahway,  N.  J.  1956). 


THE  FIRST  meprobamate  PREDNISOLONE  THERAPY 


meprobamate  to  relieve  muscle  spasm 
prednisolone  to  suppress  inflammation 

relieves  both 
muscle  spasm 
and  joint  inflammation 


rheumatoid  arthritis 
involves  both 
joints  and 
muscles 

only 


MERCK  SHARP  & DOHME  Philadelphia  1,  Pa. 

Division  of  MERCK  & CO.,  Inc. 


In  Upper  Respiratory  Tract  Infections  . . . 

for  symptomatic  relief  and 
prevention  of  bacterial  complications 


Pen  -Vee  • Qdiri 


Penicillin  V with  Salicylamide,  Promethazine  Hydrochloride,  Phenacetin,  and  Mephentermine  Sulfate,  Wyeth 


® 

Philadelphia!,  Pa. 


Supplied:  Capsules,  bottles  of  36.  Each  capsule  contains 
penicillin  V,  62.5  mg.  (100,000  units) ; salicylamide,  194  mg.; 
promethazine  hydrochloride,  6.25  mg.;  phenacetin,  130  mg.; 
mephentermine  sulfate,  3 mg. 

antibacterial 

analgesic 

antipyretic 

mood-ameliorating 

sedative 

antihistaminic 


YOUR 
INVITATION 
TO  ACTION 


This  advcftisement  con- 
forms to  the  Code  for 
Advertising  of  the  Physi- 
cians’ Council  for  Infor- 
mation on  Child  Health. 


PEN*VEE*Cidm  in  your  practice. 

For  a generous  clinical  supply  and  professional  literature,  write 
to  Professional  Service  Department  A,  Wyeth,  P.O.  Box  8299, 
Philadelphia  1,  Pennsylvania. 


S.DJ.O.M.  APRIL  1958  - ADV. 


IT  DOESN'T  STOP  THE  PATIENT 


>'  imm 

...and  fora  nutritional  buildup 
plus  freedom  from  ieg  cramps*  * 

STORCAVITE* 


BONADOXIN  brings  relief  to  88.1% 
of  patients ...  often  within  a few  hours.’-^ 
But  it  does  not  produce  drowsiness,  or 
side  effects  associated  with  over-potent 
antinauseants.  With  safe  BONADOXIN, 
“toxicity  and  intolerance ...  [is]  zero."2 

Is  she  blue  at  breakfast?  Prescribe 
BONADOXIN.  Usually  just  one  tablet  at 
bedtime  stops  nausea  and  vomiting 
of  pregnancy . . . 


BONADOXIN^ 

STOPS  liORNINO  SICKNESS... BUT 


phosphate-free  calcium,  10  essential 
vitamins,  8 important  minerals. 

Bottles  of  100. 

*<lue  to  caleiuffl-phosphoras  imbalance  * 


NEW  YORK  17,  NEW  YORK 
Division,  Chas.  Pfizer  & Co.,  Inc. 


and  just  one  supplies  the  a 
full  50  mg.  of  pyridoxine.  >r — ' 
EACH  TABLET  CONTAINS: 


MECLIZINE  HCI 25  mg. 

PYRIDOXINE  HCI 50  mg. 


Bottles  of  25  and  100. 

References:  1.  Groskloss,  H.  H.,  et  ah  Clin. 
Med.  2:885  (Sept.)  1955.  2.  Goldsmith,  J.  W.s 
Minnesota  Med.  40:99  (Feb.)  1957. 


DIRECTORY 


THE  SOUTH  DAKOTA  STATE  MEDICAL  ASSOCIATION 
Organized  1882  300  First  Nat’l  Bank  Bldg. 

Sioux  Falls,  South  Dakota 
OFFICERS,  1957-1958 
President 

M.  M.  Morrissey,  M.D.  — — - — Pierre 

President-Elect 

A.  A.  Lampert,  M.D — Rapid  City 

Secretary-Treasurer 

A.  P.  Reding,  M.D Marion 

Vice  President 

R.  A.  Buchanan,  M.D Huron 

AMA  Delegate 

A.  A.  Lampert,  M.D Rapid  City 

Alternate  Delegate  to  AMA 

A.  P.  Reding,  M.D Marion 

Chairman  of  the  Council 

Magni  Davidson,  M.D.  Brookings 

Speaker  of  the  House 

C.  R.  Stoltz,  M.D Watertown 

Councilor-at-Large 

A.  P.  Peeke,  M.D - Volga 

COUNCILORS 
First  District  (Aberdeen) 

P.  V.  McCarthy,  M.D.  (1959)  Aberdeen 

Second  District  (Watertown) 


J.  J.  Stransky,  M.D.  (1959)  Watertown 

Third  District  (Brookings-Mudison) 

Magni  Davidson,  M.D.  (1960)  Brookings 

Fourth  District  (Pierre) 

L.  C.  Askwig,  M.D.  (1959)  Pierre 

Fifth  District  (Huron) 

Paul  Hohm,  M.D.  (1960)  Huron 

Sixth  District  (Mitchell) 

P.  P.  Brogdon,  M.D.  (1960)  Mitchell 

Seventh  District  (Sioux  Falls) 

C.  J.  McDonald.  M.D.  (1960)  Sioux  Falls 

Eighth  District  (Yankton) 

T.  H.  Sattler,  M.D.  (1959)  Yankton 

Ninth  District  (Black  HUls) 

J.  D.  Bailey,  M.D.  (1958)  Rapid  City 

Tenth  District  (Rosebud) 

R.  H.  Hayes,  M.D.  (1958)  Winner 

Eleventh  District  (Northwest) 

G.  C.  Torkildson,  M.D.  (1958)  ...McLaughlin 

Twelfth  District  (Whetstone) 

E.  A.  Johnson,  M.D.  (1958)  Milbank 


STANDING  COMMITTEES- 
Scientific  Work 

M.  M.  Morrissey,  M.D.,  Chr 

A.  A.  Lampert,  M.D 

R.  A.  Buchanan,  M.D.  

A.  P.  Reding,  M.D.  

Legislation 

H.  Russell  Brown,  M.D.,  Chr 

R.  E.  Van  Demark,  M.D.  . 

E.  T.  Ruud,  M.D 

Paul  Bunker,  M.D 

C.  L.  Swanson,  M.D.  

H.  R.  Lewis,  M.D. 


1957-1958 


Pierre 

. Rapid  City 

Huron 

Marion 


. . Watertown 
..Sioux  Falls 
...Rapid  City 

Aberdeen 

Pierre 

Mitchell 


Publications 

R.  G.  Mayer,  M.D.,  Chr.  (1960)  (Deceased).. Aberdeen 

R.  E.  Van  Demark,  M.D.  (1958)  Sioux  Falls 


T.  H.  Sattler,  M.D.  (1959) 

Medical  Defense 

A.  P.  Reding,  M.D.,  Chr.  (1958)  

Russell  Orr,  M.D.  (1959)  

D.  R.  Mabee,  M.D.  (1960)  


..Yankton 


Medical  School  Affairs 
Medical  Education  and  Hospitals 

C.  B.  McVay,  M.D.,  Chr.  (1960)  

R.  C.  Jahraus,  M.D.  (1960)  

Ronald  Price,  M.D.  (1958)  

F.  D.  Gillis,  Jr.,  M.D.  (1958)  

W.  H.  Saxton,  M.D.  (1959)  

F.  R.  Williams.  M.D.  (1959)  

Medical  Economics 

M.  Davidson,  M.D.,  Chr.  (1958)  

Abner  Willen,  M.D.  (1959)  

R.  H.  Hayes,  M.D.  (1960) 


Marion 

..Sioux  Falls 
...Mitchell 


Yankton 

Pierre 

Armour 


.Mitchell 

Huron 

..Rapid  City 

...Brookings 

Clark 

Winner 


Necrology 

D.  J.  Glood,  M.D.,  Chr.  (1958)  

J.  C.  Murphy,  M.D.  (1960)  

J.  T.  Cowan,  M.D.  (1959)  

Public  Health 

R.  K.  Rank,  M.D.,  Chr.  (1959)  

F.  C.  Totten,  M.D.  (1958)  

N.  E.  Wessman,  M.D.  (1960)  

Cancer 

P.  V.  McCarthy,  M.D.,  Chr.  (1960)  

W.  A.  Geib,  M.D.  (1958) 


..Viborg 

..Murdo 

..Pierre 


Aberdeen 

Lemmon 


J.  V.  McGreevy,  M.D.  (1959)  

T uberculosis 

W.  L.  Meyer,  M.D.,  Chr.  (1960)  

R.  G.  Meyer,  M.D.,  Chr.  (1960)  

Saul  Friefeld,  M.D.  (1959)  

Maternal  & Child  Welfare 
Brooks  Ranney,  M.D.,  Chr.  (1959) 

L.  W.  Tobin,  M.D.  (1958) 

W.  A.  Anderson,  M.D.  (1960)  

Diabetes 

E.  W.  Sanderson,  M.D.  (1958)  

M.  E.  Sanders,  M.D.  (1959)  

Clifford  Gryte,  M.D.  (1960)  


-...Sioux  Falls 


Aberdeen 

Rapid  City 

Sioux  Falls 


(Deceased).. 


Sanator 

. Aberdeen 
..Brookings 


-Yankton 
..Mitchell 
..  Sioux  Falls 


..Sioux  Falls 

Redfield 

Huron 


Executive  Committee 

M.  M.  Morrissey,  M.D.,  Chr.  Pierre 

A.  A.  Lampert,  M.D Rapid  City 

R.  A.  Buchanan,  M.D.  Huron 

C.  R.  Stoltz,  M.D Watertown 

A.  P.  Reding,  M.D -Marion 

Magni  Davidson,  M.D JBrookings 

Grievance  Committee 

L.  J.  Pankow,  M.D.,  Chr.  (1962)  Sioux  Falls 

R.  E.  Jernstrom,  M.D.  (1958)  Rapid  City 

D.  A.  Gregory,  M.D.  (1959)  Milbank 

A.  W.  Spiry,  M.D.  (1960)  ...Mobridge 

D.  S.  Baughman,  M.D.  (1961)  Madison 

Mental  Health 

George  Smith,  M.D.,  Chr.  (1960)  Sioux  Falls 

E.  S.  Watson,  M.D.  (1958)  Brookings 

Clark  Johnson,  M.D.  (1958)  Yankton 

R.  C.  Knowles,  M.D.  (1959)  Sioux  Falls 

H.  E.  Davidson,  M.D.  (1959)  Lead 

C.  G.  Baker,  M.D.  (1960)  ..Yankton 

Benevolent  Fund 

W.  E.  Donahoe,  M.D.,  Chr.  (1960)  Sioux  Falls 

J.  C.  Hagin,  M.D.  (1958)  Miller 

F.  C.  Totten,  M.D.  (1959)  .Lemmon 

Rheumatic  Fever  and  Heart  Disease 
J.  Argabrite,  M.D.,  Chr.  (1958)  Watertown 

B.  T.  Lenz,  M.D.  (1959)  Huron 

H.  W.  Farrell,  M.D.  (1960)  —Sioux  Falls 

SPECIAL  COMMITTEES 
Radio  Broadcasts  and  Telecasts  Committee 

J.  J.  Stransky,  M.D.,  Chr.  ....Watertown 

J.  P.  Steele,  M.D Yankton 

J.  C.  Rodine,  M.D Aberdeen 

Robert  Olson,  M.D Sioux  Falls 

Wm.  Fritz,  M.D Mitchell 

F.  D.  Leigh,  M.D Huron 

S.  B.  Simon,  M.D Pierre 

H.  L.  Ahrlin,  M.D Rapid  City 

American  Medical 
Education  Foundation 

A.  P.  Reding,  M.D.,  Chr.  ....  Marion 

A.  A.  Lampert,  M.D Rapid  City 

O.  J.  Mabee,  M.D.  . — Mitchell 

H.  L.  Saylor,  Jr.,  M.D Huron 

S.  F.  Sherrill,  M.D Belle  Fourche 

Editorial 

R.  G.  Mayer,  M.D (Deceased) -.Aberdeen 

G.  S.  Paulson,  M.D.  ...Rapid  City 

Harold  Lowe,  M.D ...Mobridge 

H.  R.  Wold,  M.D Madison 

R.  E.  Van  Demark,  M.D.  Sioux  Falls 

T.  W.  Reul,  M.D - Watertown 

Mary  Price,  M.D.  ..Armour 

Amos  Michael,  M.D.  .Vermillion 

M.  L.  Spain,  M.D Rapid  City 

Medical  Licensure 

F.  F.  Pfister,  M.D Webster 

Magni  Davidson,  M.D Brookings 

C.  E.  Kemper,  M.D — Viborg 

Veterans  Administration  and  Military  Affairs 

L.  C.  Askwig,  M.D.,  Chr.  Pierre 

M.  R.  Gelber,  M.D Aberdeen 

G.  H.  Steele,  M.D.  - Aberdeen 

T.  J.  Billion,  M.D Sioux  Falls 

Spafford  Memorial  Fund 

T.  E.  Eyres,  M.D.  Vermillion 

Prepayment  and  Insurance  Plans 

C.  J.  McDonald,  M.D.,  Chr Sioux  Falls 

D.  H.  Breit,  M.D.  Sioux  Falls 

Paul  Hohm,  M.D Huron 

E.  A.  Johnson,  M.D Milbank 

A.  A.  Lampert,  M.D — Rapid  City 

Robert  Monk,  M.D.  Yankton 

T.  H.  Sattler,  M.D.  Yankton 

Rural  Medical  Service 

A.  P.  Peeke,  M.D.,  Chr Volga 

G.  J.  Bloemendaal,  M.D.  Ipswich 

E.  F.  Kalda,  M.D.  Platte 

Nursing  Training 

J.  A.  Muggly,  M.D.,  Chr.  Madison 

C.  L.  Vogele,  M.D Aberdeen 

G.  F.  Gryte,  M.D.  Huron 

Workmen’s  Compensation 

J.  N.  Hamm,  M.D.,  Chr Sturgis 

H.  R.  Lewis,  M.D.  Mitchell 

R.  Giebink,  M.D Sioux  Falls 

Blood  Banks 

W.  A.  Geib,  M.D.,  Chr Rapid  City 

R.  L.  Carefoot,  M.D.  Huron 

A.  K.  Myrabo,  M.D.  Sioux  Falls 

Rehabilitation  Committee 

R.  E.  Van  Demark,  M.D.,  Chr Sioux  Falls  li 

Paul  Bunker,  M.D Aberdeen  r 

W.  A.  Dawley,  M.D.  Rapid  City  ! 

H.  L.  Ahrlin,  M.D Rapid  City  I 

Mary  Schmidt,  M.D.  Watertown  i 

Press  Radio  Committee  } 

R.  E.  Jernstrom,  M.D.,  Chr.  , Rapid  City  ; 

E.  A.  Rudolph,  M.D.  ...Aberdeen  ! 

Steve  Brzica,  M.D Sioux  Falls  1 

Care  of  the  Indigent  i 

H.  P.  Adams,  M.D.,  Chr Huron  I 

A.  P.  Peeke,  M.D Volga  | 

H.  Russell  Brown,  M.D Watertown  t 

R.  A.  Boyce,  M.D.  . Rapid  City 

P.  V.  McCarthy,  M.D Aberdeen  i 

E.  J.  Perry,  M.D -Redfield 

R.  F.  Hubner,  M.D Yankton 

C.  A.  Johnson,  M.D Lemmon 


S.D.J.O.M.  APRIL  1958  - ADV. 


19 


New. . . 

meprobamate 

prolonged 

release 

capsules 


Evenly  sustain  relaxation  of  mind  and  muscle  'rouud  the  clock 


Meprospan* 

MEPROBAMATE  IN  PROLONGED  RELEASE  CAPSULES 

■ maintains  constant  level  of  relaxation 

■ minimizes  the  possibility  of  side  effects 

■ simplifies  patient’s  dosage  schedule 

Dosage:  Two  Meprospan  capsules  q.  12  h. 

Supplied : Bottles  of  30  capsules. 

Each  capsule  contains : 

Meprobamate  (Wallace)  200  mg. 

2-methyI-2*n-propyl”l,3'propanediol  dicarbamate 

literature  and  samples  on  request, 

. WALLACE  LABORATORIES,  New  BruTiswicky  N.  J. 

^fRAOe-MAAll  CM£*6598.4a 


20 


S.D.J.O.M.  APRIL  1958  - ADV. 


N0W...A  NEW  TREATMENT 


'Cardilate'  tablets  shaped  for  easy  retention 

in  the  buccal  pouch 

**. . . the  degree  of  increase  in  exercise  tolerance  which  sublingual  ery- 
throl  tetranitrate  permits,  approximates  that  of  nitroglycerin,  amyl 
nitrite  and  octyl  nitrite  more  closely  than  does  any  other  of  the  approxi- 
mately 100  preparations  tested  to  date  in  this  laboratory.” 

“Furthermore,  the  duration  of  this  beneficial  action  is  prolonged  suffi- 
ciently to  make  this  method  of  treatment  of  practical  clinical  value.” 


Riseman,  J.  E.  F.,  Altman.  G.  E.,  and  Koretsky,  S.: 
Nitroglycerin  and  Other  Nitrites  in  the  Treatment  of 
Angina  Pectoris,  Circulation  (Jan.)  1958. 

*“Cardirate’  brand  Crythrot  Tetranitrate  SUBLINGUAL  TABLETS,  15  mg.  scored 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC.,  Tuckahoe,  New  York 


S.D.J.O.M.  APRIL  1958  - ADV. 


21 


JOINTS  INVOLVED  IN  GOUT 

1 INITIAL  SUSSEOlttNT 

1 ATTACK  ATTACKS  ^ I 

'h  ‘1 

1 m 1 

M 10%  y 

Ill  u|  II 

\jj  16% 

1 H 1 i 

H-  ' 

1,  Recurrent  joint  pain  followed  by- 
long  periods  of  complete  remis- 
sion. (Percentages  refer  to  inci- 
dence.) 


SIRUM  URIC  ACID 
CONCENTRATION 


3. 


Elevated  serum  uric  acid  levels. 


2 ■ Enlargement  of  bursae  such  as  in 
this  case  involving  the  olecranon 
bursa. 


4i  Colchicine  test:  full  dose  (0.5 
mg.)  every  1 to  2 hours  until  pain 
is  relieved  or  nausea,  vomiting  or 
diarrhea  occur.  The  test  requires 
usually  8 to  16  doses.  Pain  relief 
is  highly  indicative  of  gout. 


FROM  THESE  FINDINGS... SUSPECT  GOUT; 

^BENEMID 


PROBENECID 


A SPECIFIC  FCR  GOUT 


Once  findings  point  to  gout,  long-term  management  can  be  started 
with  Benemid.  This  effective  uricosuric  agent  has  these  unique 
benefits: 


• Urinary  excretion  of  uric  acid  is  approximately  doubled. 

• Serum  uric  acid  levels  are  reduced. 

• Uric  acid  deposits  (tophi)  in  tissues  are  mobilized. 

• Formation  of  new  tophi  can  often  be  prevented. 

• Fewer  attacks  and  severity  is  reduced. 


RECOMMENDED  DOSAGE:  0.25  Gm.  (%  tablet)  twice  daily  for 
one  week  followed  by  1 Gm.  (2  tablets)  daily  in  divided  doses. 


MERCK  SHARP  & DOHME 


Benemid  is  a trade-mark  of  Merck  & Co.,  Inc. 


DIVISION  OF  MERCK  & CO.,  Inc.,  PHILADELPHIA  1,  PA. 


22 


S.DJ.O.M.  APRIL  1958  - ADV. 


• debilitated 

• elderly 

• diabetics 

• infants,  especially  prematures 

• those  on  corticoids 

• those  who  developed  moniliasis  on  previous 
broad-spectrum  therapy 

• those  on  prolonged  and/or 
high  antibiotic  dosage 

• women— especially  if  pregnant  or  diabetic 


the  best  broad-spectrum  antibiotic  to  use  is 


MYSTECLIN-V 


Squibb  Tetracycline  Phosphate  Complex  (Sumycin)  and  Nystatin  (Mycostatin) 


Sumycin  plus  Mycostatin 


for  practical  purposes,  Mysteclin-V  is  sodium-free 


for  ^^built-in"  safety,  Mysteolin -V  combines: 

1-  Tetracycline  phosphate  complex  (Sumycin)  for  superior 
initial  tetracycline  blood  levels,  assuring  fast  transport  of 
adequate  tetracycline  to  the  infection  site. 

Z.  Mycostatin— the  first  safe  antifungal  antibiotic— for  its 
specific  antimonilial  activity.  Mycostatin  protects 
many  patients  (see  above)  who  are  particularly  prone  to  monilial 
complications  when  on  broad-spectrum  therapy. 


Capsules  (2S0  ms./250.000  u.),  bottles 
of  16  and  100.  Half-Strength  Capeidee 
(125  ing./125,000  u.),  bottles  of  16 
and  100.  Suspension  (125  mg./125,000 
u.),  2 02.  bottles.  Pediatric  Drape  (100 
nig./100,000  u.),  10  cc.  dropper  bottles. 


Squibb 


Squibb  Quality— 
the  Priceless  Ingredient 


MYST6CLIN-V  PREVENTS  MONIblAl.  OVERGROWTH 


25  PATIENTS  ON 
TETRACYCLINE  ALONE 

After  seven  days 
of  therapy 


Before  therapy 

% m m % ^ 


25  PATIENTS  ON 

TETRACYCLINE  PLUS  MYCOSTATIN 
After  seven  days 
of  therapy 


Before  therapy 
® 2 


• • 


• • • e • 


m « - « 


• m 9 m 


Monilial  overgrowth  (rectal  swab)  % None  • Scanty  • Heavy 

Childs,  A.  J.:  British  M.  J.  1:660  1956. 


•MYSTECtlK,-*  -MyCOSTATm-.e  a> 


HBB  TMaDCMAHM 


(Sulfacetamide  Sodium  U.S.R— 5 and  15  cc.  dropper 


for  simultaneously  combating 
inflammation,  allergy,  infection 


(0.5%  prednisolone  acetate  and  10%  sulfacetamide  sodium  — 
5 cc.  dropper  bottle) 


■liSSK'S; 

(0.5%  prednisolone  acetate,  10%  sulfacetamide  sodium  and 
0.25%  neomycin  sulfate— oz.  tube) 


allergies., 


opnthalmic 


suspension 


(0.2%  prednisolone 
acetate  and 
0.3%  Chlor-Trimeton®— 
H 5 cc.  dropper 

9 bottle) 


..  (15  cc.  dropper  bottle) 

'.'-V 


”>■ 


•V  <»  »,«*.) 

, ‘i?  ■% 


g;/..  j 


SCHERING  CORPORATION  • BLOOMFIELD,  NEW  JERSEY 


1 


24 


S.DJ.O.M.  APRIL  1958  - ADV. 


IN 


At  the  last  accounting,!  physicians  throughout  the  coun- 
try had  administered  at  least  one  dose  of  poliomyelitis 
vaccine  to  64  million  Americans— -aU  three  doses  to  an 
estimated  34  million.  Undoubtedly,  these  inoculations 
have  played  a major  part  in  the  dramatic  reduction  of 
paralytic  poliomyelitis  in  this  coxmtry. 


Incidence  of  polio  in  the  United  States,  1952-1957 
(data  compiled  from  U.S.P.H.S.  reports) 


vaccine  is  plentiful  for  the  job  remaining 

There  are  stiQ  more  than  45  million  Americans  tmder 
forty  who  have  received  no  vaccine  at  all  and  many 
more  who  have  taken  only  one  or  two  doses. 

As  it  was  phrased  in  a public  statement  by  the  Depart- 
ment of  Health,  Education,  and  Welfare: 

will  be  a tragedy  if,  simply  because  of  public 
apathy,  vaccine  which  might  prevent  paralysis  or  even 
death  lies  on  the  shelf  unused.’”^ 

Eli  Lilly  and  Company  is  prepared  to  assist  you  and 
your  local  medical  society  to  reach  those  individuals  who 
stiU  lack  full  protection.  For  information  see  your  Lilly 
representative. 

1.  J.  A.  M.  A.,  165:27  {November  23) , 1957. 

2.  Department  of  Healthy  Education^  and  Welfare:  News  ReleasCy  October  10, 
1957, 

ELI  LILLY  AND  COMPANY  . INDIANAPOLIS  6,  INDIANA,  U.  S.  A. 

849008 


S.D.J.O.M.  APRIL  1958  - ADV. 


25 


Floraquin®  eliminates 
trichomonal  and  mycotic  infection; 
restores  normal  vaginal  acidity 


Leukorrhea  is  by  far  the  most  frequent  symp- 
tom of  vaginitis;  trichomonads  and  monilia  are 
the  most  common  causes.  Many  authors  have 
reported^  trichomonal  protozoa  in  the  vagina 
of  25  per  cent  of  obstetric  and  gynecologic 
patients.  Increased  use  of  broad  spectrum 
antibiotics  has  resulted  in  a sharp  rise  in  the 
incidence  of  monilial  infections. 

Floraquin  effectively  eradicates  both  tricho- 
monal and  monilial  vaginal  infections  through 
the  action  of  its  Diodoquin®  content.  Floraquin 
also  furnishes  boric  acid  and  sugar  to  restore 
the  normal  vaginal  acidity  which  inhibits  patho- 


gens and  favors  the  growth  of  protective  Dbder- 
lein  bacilli. 

Pitti  recommends  vaginal  insufflation  of 
Floraquin  powder  daily  for  three  to  five  days, 
followed  by  acid  douches  and  the  daily  inser- 
tion of  Floraquin  vaginal  tablets  throughout  one 
or  two  menstrual  cycles.  G.  D.  Searle  & Co., 
Chicago  80,  Illinois.  Research  in  the  Service  of 
Medicine. 


1.  Pitt,  M.  B.:  Leukorrhea.  Causes  and  Management,  J.  M. 
A.  Alabama  25.182  (Feb.)  1956. 

2.  Parker,  R.  T.;  Jones,  C.  P.,  and  Thomas,  W.  L. : Pruritus 
Vulvae,  North  Carolina  M.  J.  16:510  (Dec.)  1955. 


k 


26 


S.D.J.O.M.  APRIL  1958  - ADV. 


THE  SOUTH  DAKOTA  JOURNAL 
OF  MEDICINE 

300  First  National  Bank  Sioux  Falls,  S.  D. 

Subscription  $2.00  per  year  20c  per  copy 

CONTRIBUTORS 

MANUSCRIPTS:  Material  appearing  in  all  publi- 
cations of  the  Journal  of  Medicine  should  be  type- 
written, double-spaced  and  the  original  copy,  not 
the  carbon  should  be  submitted.  Footnotes  should 
conform  with  this  request  as  well  as  the  name  of 
author,  title  of  article  and  the  location  of  the  author 
when  manuscript  was  submitted.  The  used  manu- 
script is  not  returned  but  every  effort  will  be  used 


to  return  manuscripts  not  accepted  or  published 
by  the  Journal  of  Medicine. 

ILLUSTRATIONS:  Half-tones  and  zinc  etchings 
will  be  furnished  by  The  South  Dakota  Journal  of 
Medicine  when  satisfactory  photographs  or  draw- 
ings are  supplied  by  the  author.  Each  illustration, 
table,  etc.,  should  bear  the  author’s  name  on  the 
back.  Photographs  should  be  clear  and  distinct. 
Drawings  should  be  made  in  black  India  ink  on 
white  paper.  Used  illustrations  are  returned  after 
publication,  if  requested. 

REPRINTS:  Reprints  should  be  ordered  when 
galley  proofs  are  submitted  to  the  authors.  Type 
left  standing  over  30  days  will  be  destroyed  and 
no  reprint  orders  will  be  taken.  All  reprint  orders 
should  be  made  directly  to  the  South  Dakota 
Journal  of  Medicine,  300  First  Natl  Bank,  Sioux 
Falls,  South  Dakota. 


(Continued  from  Page  12) 

Committee  on  Civil  Defense 

T.  r As;kwig,  MD,  Phr 

Ipswich 

P.  V.  McCarthy,  M.D. 

Commission  for  Improvement  of  Patient 

Care 

R.  Delaney,  M.D.,  Chr.  DSfiOl 

Mitchell 

M M D nfifiO) 

Rodfiold 

r.  T.  Vn^PlP,  MFI 

r.  F arytf^,  MD 

Huron 

.T.  A.  Miiggiy,  M.n 

Madison 

Committee  on  School  Health 

R.  O.  Mayf^r,  MD.,  Phr 

W-  A.  Andprson,  M.D 

Sioux  Falls 

.Rapid  City 

Committee  on  Budget  and  Audit 

A.  P.  Rpding,  M.D.,  Phr. 

A.  A.  Tiampf=irt,  M.D. 

C.  R .Stolt?.,  M.n 

Hunters  Fall  Medical  Meeting 

W.  A.  Delanpy,  M.D.,  Phr 

Mitrbf-n 

H.  R.  Lewis,  M.D.  

Mitchell 

T,.  W.  Tobin,  MD 

Mitrholl 

Committee  on  Aging 

Warren  .lone.s,  M.D.,  Chr. 

J.  W.  Argahrite,  M.D 

M.  P.  Merryman.  M.D.  

DISTRICT  OFFICERS 

DISTRICT  1 

President  A.  Keegan,  M.D.,  Aberdeen,  S.  D. 

Vice-President G.  H.  Steele,  M.D.,  Aberdeen,  S.  D. 

Secretary-Treasurer W.  E.  Gorder,  M.D.,  Aberdeen,  S.  D. 


DISTRICT  2 

President  . S.  W.  Allen,  Jr.,  M.D.,  Watertown,  S.  D. 

Vice-President  B.  Brewster,  M.D.,  Watertown,  S.  D. 

Secretary-Treasurer  . ...T.  J.  Wrage,  Jr.,  M.D.  Watertown,  S.  D. 


DISTRICT  4 

President R.  C.  Jahraus,  M.D.,  Pierre,  S.  D. 

Vice-President  J.  C.  Murphy,  M.D.,  Murdo,  S.  D. 


Secretary-Treasurer J.  T.  Cowan,  M.D.,  Pierre,  S.  D. 


DISTRICT  5 

President Ted  Hohm,  M.D.,  Huron,  S.  D. 

Vice-President Roscoe  Dean,  M.D.,  Wess.  Springs,  S.  D. 

Secretary-Treasurer _..  Fred  Leigh,  M.D.,  Huron,  S.  D. 


DISTRICT  6 

President W.  S.  Peiper,  M.D.,  Mitchell,  S.  D. 

Vice-President D.  R.  Nelimark,  M.D.,  Mitchell,  S.  D. 

Secretary-Treasurer T.  A.  Pollerman,  M.D.,  Alexandria,  S.  D. 


DISTRICT  7 

President  F.  C.  Kohlmeyer,  M.D.,  Sioux  Falls,  S.  D. 

Vice-President C.  S.  Larson,  M.D.,  Sioux  Falls,  S.  D. 

Secretary A.  K.  Myrabo,  M.D.,  Sioux  Falls,  S.  D. 

Treasurer  D.  L.  Ensberg,  M.D.,  Sioux  Falls,  S.  D. 


DISTRICT  8 

President  R.  Monk,  M.D.,  Yankton,  S.  D. 

Vice-President A.  C.  Michael,  M.D.,  Vermillion,  S.  D. 

Secretary W.  F.  Strange,  M.D.,  Yankton,  S.  D. 

Treasurer  A.  Andre,  M.D.,  Vermillion,  S.  D. 

DISTRICT  9 

President  S.  F.  Sherrill,  M.D.,  Belle  Fourche,  S.  D. 

Vice-President  R.  Boyce,  M.D.,  Rapid  City,  S.  D. 

Secretary-Treasurer Wayne  Geib,  M.D.,  Rapid  City,  S.  D. 


DISTRICT  10 

President  F.  J.  Clark,  M.D.,  Gregory,  S.  D. 

Secretary-Treasurer  Peter  Lakstigala,  M.D.,  White  River,  S.  D. 

DISTRICT  11 

President Alexander  Stephans,  M.D.,  Selby,  S.  D. 

Secretary-Treasurer B.  P.  Nolan,  M.D.,  Mobridge,  S.  D. 


DISTRICT  3 

President  S.  E.  Friefeld,  M.D.,  Brookings,  S.  D. 

Vice-President C.  S.  Roberts,  Jr.,  M.D.,  Brookings,  S.  D. 

Secretary-Treasurer C.  M.  Kershner,  M.D.,  Brookings,  S.  D. 


DISTRICT  12 

President  ...  W.  C.  Brinkman,  M.D.,  Sisseton,  S.  D. 

Secretary-Treasurer  D.  A.  Gregory,  M.D.,  Milbank,  S.  D. 


SELECTIVE  PITUITARY  FAILURE 
Report  of  Case  of  Isolated  Thyrotropic 
Insufficiency 

By  Gordon  S.  Paulson,  M.D.  and 
Nathaniel  R.  Whitney,  M.D. 
Rapid  City,  South  Dakota 


The  usual  basis  for  the  diagnosis  of  pit- 
uitary insufficiency  is  the  concomitant  oc- 
currence of  clinical  and  laboratory  evidence 
of  hypogonadism,  hypothyroidism  and  hypo- 
adrenocorticism. This  concept  of  pituitary  in- 
sufficiency, embodied  in  the  diagnostic  term 
panhypopituitarism,  stems  from  the  dual  pre- 
sumption that  only  by  sheer  coincidence 
would  a deficiency  of  the  three  target  glands 
occur  independently  of  each  other,  and  that 
destructive  lesions  of  the  pituitary  involve 
the  various  functions  of  the  gland  equally 
and  unselectively.  The  validity  of  the  former 
presumption  is  not  questioned,  but  there  are 
numerous  reasons,  both  logical  and  factual, 
to  believe  that  the  latter  is  more  convenient 
than  it  is  accurate.  As  will  be  detailed  below, 
there  is  a growing  mass  of  evidence,  particu- 
larly since  the  advent  of  the  radioactive  tracer 
as  a tool  for  study,  that  pituitary  deficiency 
can  manifest  itself  as  a deficiency  of  only 
one  or  two  of  the  target  organs  and  that  the 
older  concept  that  all  three  of  the  readily 
measurable  target  glands  must  be  deficient  to 
incriminate  the  pituitary,  is  becoming  ob- 
solete. The  term  Selective  Pituitary  Failure 
has  been  employed  appropriately  by  Had- 
dock, Leach,  Kline  and  Myers  ^ to  denote  this 
condition.  The  case  to  be  presented  here  is 
one  of  apparent  thyrotropin  deficiency  in  the 
presence  of  intact  gonadotropin  and  adreno- 


corticotropin  secretion,  and  its  report  has 
been  motivated  for  the  purpose  of  further 
documenting  the  occurrence  of  selective  pit- 
iitiary  failure. 

This  case  report  concerns  a 20  year  old 
male  farm  worker  who  consulted  the  phys- 
ician because  of  a number  of  inadequacies 
apparently  present  since  early  childhood.  His 
birth  and  early  development  were  regarded 
as  normal  except  for  the  fact  that  he  did  not 
walk  until  the  age  of  16  months,  at  which 
time,  his  walk  was  described  as  an  unusual 
waddle.  The  parents  quote  the  attending 
physician  as  making  a diagnosis  of  congenital 
dislocation  of  the  hip,  but  x-rays  were  alleged 
to  have  shown  retardation  in  the  ossification 
of  the  femoral  heads.  Walking  improved  fol- 
lowing a series  of  chiropractic  treatments. 
The  patient  did  satisfactorily  during  his  first 
year  in  school  at  the  age  of  six  years.  During 
his  second  year  in  school,  he  was  brought  to 
a physician  because  of  the  realization  that  his 
physical  development  was  retarded,  (Height 
41  inches,  weight  42  pounds).  Following  the 
discovery  of  a low  basal  metabolic  rate  and 
subsequent  thyroid  therapy,  his  growth  rate, 
strength  and  energy  seemed  to  increase.  He 
had  taken  no  thyroid  since  it  was  discon- 
tinued by  his  doctor  a year  and  a half  later. 
Except  for  occasional  iron  therapy,  he  had 
had  no  therapy  of  any  kind  since  his  period 


k 


— . 127  — 


SOUTH  DAKOTA 


on  thyroid.  In  subsequent  years,  he  com- 
pleted high  school. 

Although  the  patient  thought  he  had 
reached  his  present  physical  dimensions 
about  two  years  prior  to  our  examination, 
the  mother  seemed  to  think  that  he  was  still 
growing.  Coordination,  cerebration,  strength 
and  stamina  seemed  diminished  for  a youth 
of  his  age.  Occasional  erections  and  possibly 
ejaculations  had  occurred.  The  voice  had 
continued  to  assume  more  masculine  charac- 
teristics in  the  past  two  years.  His  beard  was 
relatively  sparse.  There  had  been  no  serious 
illnesses,  injuries  or  major  surgical  opera- 
tions. There  was  no  known  allergies.  The  use 
of  alcohol  and  tobacco  was  denied.  Although 
there  has  been  occasional  giddiness  since 
January  1956,  there  had  been  no  headaches, 
vertigo,  or  visual  disturbances.  The  weight 
had  been  near-constant  for  two  years,  but 
the  appetite  was  poor.  The  sweating  mechan- 
ism appeared  to  be  normal,  but  he  was  aware 
of  considerable  intolance  toward  cold.  There 
had  been  no  goiter,  respiratory  or  cardiac 
symptoms.  He  had  not  complained  of  food 
intolerance,  indigestion,  constipation,  bowel 
irregularities,  or  urinary  symptoms. 

He  was  of  Dutch-German  ancestry.  The 
father  was  living  and  well  at  age  42.  The 
mother  was  in  good  health  at  age  40.  There 
were  four  siblings,  all  living  and  well  except 
for  one  who  developed  diabetes  about  a year 
following  our  examination  of  the  patient. 
None  of  the  siblings  or  other  members  of  the 
relationship  exhibited  any  physical  similarity 
to  the  patient. 

The  physical  examination  revealed  small 
stature  and  a general  appearance  suggesting 
an  age  of  about  14  years.  He  weighed  109 
pounds  and  measured  64  inches  in  height.  His 
symphysis  to  floor  distance  was  42  inches 
and  symphysis  to  vertix  distance  likewise  32 
inches.  The  span  between  the  fingertips  of 
the  extended  arms  was  68  inches.  The  patient 
exhibited  a pleasant,  placid  disposition, 
smiled  frequently  and  actually  expressed 
very  few  complaints.  The  voice  tended  to 
crack  frequently  like  that  of  an  adolescent 
youth  and  the  facial  expression  was  cretinoid. 

The  pulse  rate  was  64  per  minute  and 
regular.  The  blood  pressure  was  104  mm  of 
mercury  systolic  and  70  mm  diastolic.  There 
was  no  goiter.  The  pupils  were  round,  re- 


active to  light,  in  accommodation,  and 
equal.  The  extraocular  movements  were  nor- 
mal. Visual  fields  by  confrontation  were 
physiological.  The  chest  was  clear  and  the 
heart  was  normal  in  size,  sounds  and  rhythm. 
The  external  genitalia  exhibited  normal  adult 
male  characteristics.  The  rectal  examination 
disclosed  a prostate  which  seemed  slightly 
smaller  than  normal.  No  skeletal,  vascular,  or 
neurologic  abnormalities  were  evident.  The 
skin  was  smooth  and  pale;  the  facial  beard 
was  sparse  and  there  was  no  hair  upon  the 
chest;  axillary  and  pubic  hair  were  normal 
in  amount  and  pattern  for  a young  adult 
male.  The  physical  examination  was  other- 
wise normal. 

Laboratory  findings  are  tabulated  in  Tables 
I and  H. 

Table  I 

Basal  Metabolic  rate  Minus  20  percent 

Protein  bound  iodine  3.8  micrograms 

X-ray  of  skull:  no  defect  seen  in  calvarium.  Sella 
within  limits  of  normal. 

X-rays  of  both  wrists:  normal  wrists  and  normal 
bone  age. 

Semen  analysis:  Sperm  count  204,000,000.  Normal 
motility. 

Testicular  biopsy:  Normal  testicular  tissue.  Normal 
spermatogenesis. 

Urine  gonadotropins:  Less  than  6 mouse  units  in 
24  hours  (Normal  6 - 50). 

Kepler-Power  water  test:  Negative.  Volume  of 
night  specimen  200  cc. 

Largest  day  specimen  220  cc. 

Blood  urea  nitrogen:  21.5  mg.  per  100  cc. 

48  hour  ACTH  test:  Total  eosinophiles  dropped 
from  124  per  cu  mm.  to  61,  after  two  ACTH 
injections.  24-hour  17-ketosteroids  increased 
from  9 mg.  during  control  period  to  11  mg  in 
first  test  period  and  13  mg  in  second  test 
period. 

Sedimentation  rate  7 mm  in  1 hour. 

(Westergren) 

Hemoglobin  12.1  grm. 

Leucocytes  6850 
Hematocrit  37 

Differential:  50  Filamented  neutrophils,  3 eosino- 
philes, 47  lymphocytes 

COMMENT 

We  believe  that  the  evidence  for  thyro- 
thropic  deficiency  with  intact  secretion  of 
adrenocorticotropin  and  intact  or  near-intact 
secretion  of  gonadotropin  is  fairly  conclusive 
in  this  case.  It  is  true  that  there  are  sugges- 
tions of  some  inadequacies  of  gonadotropic 
effect  such  as  the  sparse  facial  beard,  the 
questionably  small  prostate,  and  the  24-hour 
urinary  gonadotropin  level,  but  we  hold  that 
opposing  data  such  as  normal  semen,  normal 
testicular  biopsy,  evidence  of  normal  sexual 
function  in  the  history,  normal  external 


— 128  — 


APRIL  1958 


Table  II 


Date 

24  Hour  thyroid 
uptake 

24  Hour  urine 
Excretion 

1-131 

After  injection 
of  TSH 

24  hr.  24  hr. 

uptake  excretion 

July  25,  1956 

4 percent 

66  percent 

Aug.  15,  1956 

1.4  percent 

17.2  percent 

30  percent 

Oct.  17,  1956 

13.6  percent 

104  percent 

74  percent 

Technic  of  test  used: 

1- 50  Microcuries  of  1-131  was  given  orally 

2-  In  24  hours  the  thyroid  uptake  and  urinary 
output  were  determined.  1-131  was  given 
orally  and  10  USP  units  of  thyrotropic  hor- 
mone (Armour  Thytropar,  one  USP  unit 
equivalent  to  2.5  mg  TSH)  given  intra- 
muscularly. 

3-  In  24  hours,  the  thyroid  uptake  and  urina^ 
output  were  again  determined.  The  net  gain 
in  thyroid  uptake  was  calculated  by  sub- 
tracting the  first  24  hours  uptake  from  the 
second  24-hour  uptake. 

genitalia,  and  normal  sized  testicles,  speak 
more  convincingly. 

The  normal  result  obtained  from  the  ACTH 
test  as  measured  by  the  total  eosinophil  re- 
sponse and  the  effect  of  ACTH  upon  the  24- 
hour  17-ketosteroids  should  indicate  either 
normal  adrenal  cortices  or  adrenals  that  are 
functioning  inadequately  from  lack  of  normal 
anterior  pituitary  stimulation.  The  normal 
response  to  the  Kepler-Power  water  test 
should  make  the  decision  in  favor  of  normal- 
ity. 

The  diagnosis  of  thyroid  deficiency  is  based 
upon  the  low  basal  methabolic  rate,  the  low 
or  low  normal  protein  bound  iodine,  and  the 
consistently  low  thyroid  uptake  of  1-131.  The 
use  of  thyroid  stimulating  hormone  to  demon- 
strate the  responsiveness  of  the  hypoactive 
thyroid  to  pituitary  stimulation  and  thereby 
incriminate  the  pituitary  follows  essentially 
the  principles  used  by  Querido  and  Stan- 
bury,2  Werner^  and  others  for  that  purpose. 

The  moderate  stunting  of  growth  presented 
in  this  case  might  be  explained  by  an  inade- 
quacy of  the  growth  hormone,  a factor  which 
is  not  readily  subject  to  quantitation.  The 
fact  that  the  patient’s  other  measurements, 
namely  the  span,  symphysis-vertex  and  sym- 
physis-floor measurements  are  normal  and 
not  in  keeping  with  eunuchoidism  militates 
against  hypogonadism  as  a factor  in  his  re- 
tarded growth,  particularly  in  view  of  the 

i 


assumption  that  the  pathologic  lesion  causing 
the  present  symptoms  had  its  onset  at  birth 
or  early  in  childhood. 

Review  of  Literature 

The  term  selective  pituitary  failure  has 
been  used  by  Haddock,  Leach,  Klein,  and 
Myers’  in  describing  four  males  with  failure 
of  gonadotropin  and  ACTH  secretion  but  with 
intact  thyrotropin  secretion.  Deficiency  of 
gonadotropin  secretion  was  shown  directly 
by  clinical  signs  of  hypogonadism,  low  or 
absent  urinary  gonadotropins,  and  degenera- 
tive changes  in  testicular  biopsies.  (That 
such  Canges  in  the  testes  occur  with  pituitary 
insufficiency  has  been  shown  by  McCullagh, 
Gold,  and  McKendry^  who  describe  the  fol- 
lowing progressive  changes  in  the  testes  as 
the  pituitary  fails:  Failure  or  spermato- 
genesis, decrease  in  spermatids,  disappear- 
ance of  spermatocytes,  thickened  basement 
membranes,  diminution  and  then  disappear- 
ance of  Leydig  cells,  and  finally  diffuse  fib- 
rosis and  disappearance  of  the  Sertoli  cells.) 
Evidences  for  ACTH  deficiencies  consisted  in 
positive  responses  to  the  Kepler-Power  water 
test  in  3 subjects  in  whom  it  was  done,  dimin- 
ished urinary  17-ketosteroids,  a response  to 
the  injection  of  ACTH  following  the  pattern 
expected  in  hypopituitarism,  and  various  in- 
direct evidences.  As  evidence  that  the  thyro- 
tropin secretion  was  normal,  the  authors 
point  to  the  absence  of  the  usual  symptoms 
of  hypothyroidism;  normal  values  of  basal 
metabolic  rate;  normal  levels  of  protein  bound 
iodine;  and  1-131  uptakes  that  were  normal, 
borderline  or  slightly  depressed.  In  all  four 
cases  the  response  to  therapy  consisting  of 
ACTH  and  testosterone  was  considered  satis- 
factory. The  causes  for  pituitary  failure  in 
the  series  of  four  cases  was  not  entirely  clear: 
One  appeared  to  be  the  result  of  paresis,  an- 


— 129  — 


SOUTH  DAKOTA 


other  followed  a long  febrile  illness,  and  two 
were  unassociated  with  any  known  illness. 

Maddock,  Leach  and  associates  suggest  as 
possible  explanations  for  this  selectivity  the 
existence  of  “selective  failure”  in  which  one 
or  two  of  the  usual  three  measurable  func- 
tions of  the  pituitary  is  intact  in  the  presence 
of  failure  of  the  others;  and  the  possibility  of 
“partial  panhypopituitarism”  with  a uniform 
depression  of  all  three  functions  but  to  a 
level  adequate  for  the  function  of  one  of  the 
target  organs  but  not  adequate  for  the  others. 
The  authors  favor  the  former  possibility,  an 
hypothesis  which  would  on  logical  grounds 
require  that  the  dissociation  of  the  various 
functions  of  the  pituitary  be  explainable  ana- 
tomically as  well  as  physiologically.  In  satis- 
faction of  this  latter  requirement  they  cite 
experimental  work  that  would  indicate  that 
each  pituitary  hormone  arises  from  a specific 
cell  type.  Histologic  studies,  obviously  more 
detailed  than  are  usually  done  on  the  pit- 
uitary and  which  frequently  require  special 
stains  and  preparations  have  enabled  a finer 
differentiation  of  cells  than  the  usual  baso- 
phils, acidophills,  and  chromophobes.  Accord- 
ing to  some  studies  cited  by  the  authors, 
pituitary  basophils  can  be  divided  into  delta 
cells  giving  rise  to  gonadotropins,  beta  cells 
giving  rise  to  thyrotropin  and  another  type, 
to  ACTH. 

As  evidence  that  selective  dissociation  in 
the  various  functions  of  the  anterior  pituitary 
is  entirely  plausible,  Maddock,  Leach  and 
associates  point  out  that  this  phenomenon  is 
physiologic  in  the  prepubertal  child  in  which 
gonadotropins  are  normally  lacking;  if  this 
lack  persists  far  into  the  second  decade,  hypo- 
gonadotropic  eunnuchoidism  results. 

Russfield^  studied  the  pituitary  in  patients 
with  hypothyroidism,  hyperthyroidism,  and 
cancer  and  has  presented  evidence  that  thy- 
roid stimulating  hormone,  ACTH,  gonadotro- 
pin and  growth  hormone  arise  from  cells 
which  she  calls  hypophyseal  “aminophils.” 
Purves  and  Griesbach®  by  special  staining 
technics  distinguished  between  thyrotropic 
and  gonadotropic  basophils  in  the  rat  pitui- 
tary. The  findings  of  Purves  and  Griesback 
have  been  supported  essentially  by  Farquhar 
and  Rinehart. ”7  These  few  references  to  re- 
search efforts  directed  toward  clarifying  the 
relationship  between  the  various  tropic  hor- 
mones of  the  anterior  pituitary  and  the  cells 


which  produce  them  is  by  no  means  exhaus- 
tive but  are  mentioned  merely  to  show  that 
such  correlations  have  been  made.  Such  re- 
lationships, when  and  if  established,  will  lend 
plausibility  to  the  concept  of  “selective  pit- 
uitary failure.”  A detailed  discussion  of  this 
question  is  beyond  the  scope  of  this  paper. 

Shuman®  has  described  a case  of  hypo- 
throidism  due  to  thyrotropin  deficiency  with- 
out the  manifestations,  clinical  or  laboratory, 
of  gonadotropin  or  adrenocorticotropin  de- 
ficiencies. His  patient  was  a 64  year  old  dia- 
betic and  psychotic  negro  who  had  had  elec- 
tric shock  treatments.  The  usual  tests  were 
employed  to  establish  the  existence  of  ade- 
quate or  normal  gonadotropic  and  adreno- 
corticotropic function.  The  thyroid’s  ability 
to  respond  to  thyroid  stimulating  hormone 
from  a phase  of  definite  inactivity,  served  as 
a basis  for  the  final  diagnosis  of  thyrotropic  , 
deficiency.  The  1-131  uptake  in  24  hours  in- 
creased from  less  than  7 percent  to  68  percent 
after  three  daily  injections  of  30  mg.  of  thy- 
roid stimulating  hormone.  (TSH) 

Silverman  and  Wilkins®  have  described  a 
case  of  a five  and  one  half  year  old  child  with 
definite  clinical  evidence  of  thyroid  de- 
ficiency as  well  as  with  a basal  metabolic 
rate  of  minus  28  per  cent,  an  elevated  blood 
cholesterol,  and  retarded  bone  age.  After  the 
administration  of  a tracer  dose  of  radioactive 
iodine  there  was  no  uptake  by  the  thyroid 
gland.  When  the  test  was  repeated  after  the 
administration  of  TSH,  the  uptake  was  nor- 
mal. There  was  no  signs  of  involvement  of 
other  glands  that  would  suggest  hypopitui- 
tarism and  according  to  the  authors,  “Sub- 
sequent thyroid  therapy  has  resulted  in  en- 
tirely normal  growth  and  development,”  a 
result  not  expected  in  the  usual  case  of  pan- 
hypopituitarism. j 

Oelbaumio  in  a review  of  six  cases  of  post-  f 
partum  hypopituitarism,  stated  that  “there  ! 
may  be  a marked  dissociation  in  the  degree 
of  functional  impairment  of  the  thyroid,  ad- 
renal cortex,  and  the  gonads.”  One  of  his 
cases  was  one  of  gonadotropic  deficiency  with  I 
normal  function  of  the  thyroid  and  adrenal  ! 
cortex.  In  a second  case  there  was  slight  re- 
duction of  the  adrenal  cortical  function  in  the  f 
presence  of  normal  gonadotropin  and  thyro-  [ 
tropin  secretion.  In  the  remaining  four  cases  i 
there  was  involvement  of  all  three  target  / 
organs  in  varying  degrees  and  proportions.  | 


— 130  — 


APRIL  1958 


Although  Tucker,  Chitwood  and  Parker 
did  not  emphasize  dissociation  of  the  three 
measurable  functions  of  the  pituitary  in  their 
presentation  of  three  cases  of  pituitary  myxe- 
dema, they  did  recognize  the  possibility  of 
selectivity  of  failure  of  the  various  target 
organs.  They  stated,  “The  degree  of  de- 
ficiency of  each  gland  will  vary  in  different 
patients  and  the  amount  of  substitution 
necessary  for  each  gland  must  be  gauged 
accordingly.”  Implicit  in  this  statement  is  the 
definite  possibility  that  one  target  gland  may 
be  functioning  normally  and  others  deficient 
in  the  presence  of  a destructive  lesion  of  the 
pituitary.  They  suggest  that  as  the  pituitary 
gland  is  progressively  damaged,  the  most 
vital  function  of  maintaining  the  adrenal  cor- 
tex is  preserved  as  long  as  possible  at  the  ex- 
pense of  gonadotropic  and  thyrotropic  func- 
tions. 

Peters,  German,  Man  and  Welt  12  have  re- 
viewed a series  of  34  cases  of  pituitary  insuf- 
ficiency, most  of  them  due  to  tumors,  and 
have  concluded  that  in  the  majority  of  the 
instances  gonadal  function  is  impaired  or 
even  abolished  while  the  functions  of  the 
thyroid  and  adrenal  cortex  appeared  still  to 
be  unaffected.  Their  data  support  the  prob- 
ability that  with  destructive  lesions  of  the 
pituitary,  gonadal  function  suffers  earliest 
and  most  intensely.  They  suggest  that  the 
gonads  seem  to  possess  the  least  power  of 
automonous  activity  and  to  depend  most  on 
its  trophic  hormone  from  the  pituitary;  that 
the  adrenal  cortices  are  most  able  to  function 
without  tropic  stimulation;  and  that  the  thy- 
roid appears  to  be  between  the  other  two 
glands  in  these  respects.  In  time,  however, 
the  adrenal  cortex  and  thyroid  will  fail  with- 
out the  appropriate  humoral  stimulation. 

Querido  and  Stanbury2  cite  three  circum- 
stances where  hypothyroidism  is  a component 
of  pluriglandular  disease.  The  first  is  pan- 
hypopituitarism. The  second  is  adrenal  cor- 
tical insufficiency  secondary  to  severe  pri- 
mary hypothyroidism.  The  third  is  the  rare 
situation  of  biglandular  disease  of  the  thyroid 
and  adrenals  with  a normal  pituitary  in  which 
thyroid  fibrosis  is  accompanied  by  adrenal 
atrophy.  With  this  introduction  to  demon- 
strate the  complexity  of  the  diagnostic  prob- 
lems involved  to  make  a precise  diagnosis, 
they  proceed  to  describe  the  use  of  TSH  as  an 
aid  in  the  differentiation  of  primary  and 


secondary  hypothyroidism.  They  gave  12.5 
mg.  TSH  twice  daily  for  three  or  more  days 
and  compared  protein  bound  iodines  and 
radioactive  iodine  uptakes  before  and  after 
the  administration  of  TSH.  They  found  that 
a rise  in  the  uptake  of  1-131  occurred  in  the 
normal  thyroid,  in  the  hypoactive  thyroid  re- 
sulting from  pituitary  failure,  and  in  the  pri- 
mary myxedematous  thyroid  which  happened 
to  contain  remnants  of  normal  thyroid  tissue. 
A brief  review  of  these  three  conditions 
convinces  one  that  no  test  is  conclusive  with- 
out correlation  with  the  clinical  picture.) 
They  describe  one  case  in  whom  there  was  a 
rise  in  the  protein  bound  iodine  after  the  ad- 
ministration of  TSH  in  a case  of  presumed 
primary  myxedema.  In  this  case,  it  was  felt 
that  an  underlying  pituitary  insufficiency 
had  been  ruled  out  by  a demonstration  of  nor- 
mal glucose  tolerance,  by  a high  excretion 
of  follicle  stimulating  hormone  in  the  urine, 
and  by  a low  but  normal  urinary  17-ketos- 
teroid  excretion.  Although  the  authors  con- 
sider the  possibility  that  this  might  repre- 
sent an  instance  of  thyrotrophin  failure  with- 
out failure  of  gonadotropic  and  andrenocor- 
ticotropic  functions,  they  believed  that  it 
was  better  explained  by  the  TSH  stimulation 
of  remnants  of  normal  thyroid  tissue  in  the 
glands.  In  view  of  the  material  reviewed  in 
this  paper,  it  would  appear  that  the  hypo- 
thesis requiring  normal  remants  of  tissue  in 
the  myxedematous  gland  is  less  tenable  an 
explanation  than  that  involving  selective  pit- 
uitary failure. 

Jeffries,  Levy,  Palmer  and  Storaasli’S  have 
shown  that  the  increase  in  1-131  uptake  is 
practically  as  much  after  a single  dose  of  4 
mg  TSH  as  it  is  after  a dose  of  20  mg.  In 
seven  patients  of  primary  hypothyroidism 
given  a single  dose  of  10  mg  TSH,  there  was 
no  appreciable  change  in  the  thyroid  uptake 
of  1-131;  in  three  patients  who  had  been  tak- 
ing thyroid  given  the  same  dose,  there  was  a 
prompt  and  brisk  rise  in  the  uptake;  and  in  a 
case  with  panhypopituitarism  the  uptake  in- 
creased from  1.7  percent  before  TSH  to  9.7 
percent  three  hours  after  a single  dose  of  10 
mg  of  TSH.  It  would  appear  from  these  ob- 
servations that  the  single  dose  used  in  our 
patient  was  adequate  in  amount  and  that  the 
response  observed  by  us  was  either  that  of  a 
normal  thyroid  or  that  of  a hypoactive  gland 
due  to  lack  of  pituitary  stimulation.  The  clin- 


— 131  — 


k 


ical  picture,  the  low  basal  metabolic  rate, 
and  the  low  initial  radioactive  iodine  uptake 
bespeak  definite  thyroid  insufficiency. 

Summary  and  Conclusions 

A case  of  a twenty  year  old  male  with  ap- 
parent thyrotropin  deficiency  in  the  presence 
of  normal  adrenocorticotropic  and  probably 
normal  gonadotropic  secretion  has  been  pre- 
sented. In  keeping  with  suggestions  made 
by  other  authors  the  term  “selective  pituitary 
failure”  has  been  used  as  an  appropriate  one. 
The  evidences  for  thyroid  failure  consist  in  the 
clinical  picture;  stunted  growth;  a low  basal 
metabolic  rate;  a low  normal  protein  bound 
iodine;  and  a low  thyroid  uptake  of  radio- 
active iodine.  That  the  pituitary  played  an 
active  role  in  the  thyroid  insufficiency  was 
shown  by  a consistent  rise  in  1-131  uptake 
after  the  injection  of  thyroid  stimulating  hor- 
mone. The  bases  for  concluding  that  adreno- 
corticotropic and  gonadotropic  functions  were 
normal  were:  a normal  Kepler-Power  water 
test;  a normal  response  of  the  urine  17~ketos- 
teroids  and  total  eoseinophils  to  injected 
ACTH;  normal  secondary  sexual  character- 
istics; normal  semen;  normal  testicular  bio- 
psy; and  normal  sexual  function.  The  normal 
values  ref  err  able  to  the  gonads  just  cited 
were  accepted  as  evidence  of  normal  or  at 
least  adequate  gonadotropic  function  in  the 
face  of  low  urinary  gonadotropins. 

BIBLIOGRAPHY 

1-  HADDOCK,  W.  O.;  LEACH,  R.  B.;  KLEIN, 
S.  P.;  and  MYERS,  G.  B.;  Selective  pituitary 
failure;  an  example  characterized  by  deficient 
ACTH  and  gonadotropin  secretion  with  intact 
thyrotropin  secretion.  Am.  J.  M.  Sc.  226:  509- 
515  (Nov.)  1953. 

2-  QUERIDO,  A.  and  ST  ANBURY,  J.  B.;  The 
response  of  the  thyroid  gland  to  thyrotropic 
hormone  as  an  aid  in  the  differential  diag- 
nosis of  primary  and  secondary  hypothyroi- 
dism. J.  Clin,  Endocrinol.  10:  1192,  1951. 

3-  WERNER,  S.  C.;  A case  of  pituitary  myxe- 
dema. J.  Clin.  Endocrinol.  14:  685-689  (June) 
1954. 

4-  McCULLAGH,  E.  P.;  GOLD,  A.;  McKENDRY, 
J.  B.  R.:  Alterations  in  testicular  structure  and 
function  in  organic  disease  of  the  pituitary. 
J.  Clin.  Endocrinol.  10:  871-885  (Aug.)  1950. 

5-  RUSSFIELD,  AGNES  BURT:  Histology  of  hu- 
man pypophysis  in  thyroid  disease  — hypo- 
thyroidism, hyperthyroidism,  and  cancer.  J. 
Clin.  Endrocrinol.  15:  1393-1408,  1955. 

6-  PURVES,  H.  D.  and  GRIESBACH,  W.  E.:  The 
significance  of  the  Gomori  staining  of  the 
basophils  of  the  rat  pituitary.  Endocrinology. 

7-  FARQUHAR,  MARILYN  GIST  and  RINE- 
HART, JAMES  F.:  Cytologic  alterations  in  the 
anterior  pituitary  gland  following  thyroidec- 
tomy: An  electron  miscroscope  study.  En- 
docrinology. 55:  857-876  (Dec.)  1954. 

8-  SHUMAN,  C.  R.:  Hypothyroidism  due  to  thyro- 
tropin deficiency  without  other  manifestations 


SOUTH  DAKOTA 

hypopituitarism.  J.  Clin.  Endocrinol.  13:  795- 
800  (July)  1953. 

9-  SILVERMAN,  SAMUEL  H.  and  WILKINS, 
LAWSON:  Radioiodine  uptake  in  the  study 
of  different  types  of  hypothyroidism  in  chil- 
dren. Pediatrics  12:  288-299  (Sept.)  1953. 

10-  OELBAUM,  M.  H.:  The  variability  of  endoc- 
rine dysfunction  in  post-partum  hypopituitar- 
ism. Brit.  M.  J.'2:  110-113  (July  19)  1952. 

11-  TUCKER,  H.  ST.  G.  JR.;  CHITWOOD,  J.  L.; 
and  PARKER,  C.  P.,  JR.:  Pituitary  myxedema: 
Report  of  three  cases.  Ann.  Int.  Med.  32:  52- 
62  (Jan.)  1950. 

12-  PETERS,  JOHN  P.;  GERMAN,  WILLIAM  J.; 

MAN,  EVELYN  B.;  and  WELT,  LOUIS  G.: 
Functions  of  gonads,  thyroid,  and  adrenals  in 
hypopituitarism.  Metabolism.  3:  118-137 

(March)  1954. 

13-  JEFFRIES,  WILLIAM  McK.;  LEVY,  RICH- 
ARD P.;  PALMER,  WILLIAM  G;  and  STORA- 
ASLI,  JOHN  P.:  The  value  of  a single  injec- 
tion of  thyrotropin  in  the  diagnosis  of  obscure 
hypothyroidism.  New  England  J.  Med.  249: 
876-884  (Nov.  26)  1953. 

B.  A.  BOBB.  M.D. 

1871—1958 

Dr.  B.  A.  Bobb,  87,  one  of  Mitchell’s  pioneer 
physicians  and  surgeons,  died  of  a heart 
attack  at  his  home  in  Monrovia,  Calif.,  Thurs- 
day, March  7th,  where  he  had  lived  since  re- 
tiring in  1946. 

Funeral  services  were  held  at  the  Methodist 
Church  in  Monrovia. 

Dr.  Bobb  came  to  Mitchell  in  1894  after 
graduating  from  Northwestern  University 
School  of  Medicine  in  Evanston,  111.  He  was 
joined  in  1903  by  his  brother,  the  late  Dr.  C.  S. 
Bobb  and  in  1944,  a nephew,  the  late  Dr.  E.  C. 
Bobb,  joined  the  staff. 

Dr.  Bobb  served  as  President  of  the  South 
Dakota  State  Medical  Association  in  1904. 

Dr.  Bobb  was  instrumental  in  establishing 
the  Methodist  State  Hospital  and  the  Meth- 
odist State  School  of  Nursing  in  Mitchell.  He 
was  an  active  member  of  Kiwanis  Club  and 
continued  his  membership  at  Monrovia. 

He  had  been  active  up  to  the  time  of  his 
death.  The  previous  Sunday  he  had  attended 
a dinner  at  the  Glendale  Methodist  Church 
for  the  Dakota  Wesleyan  University  choir, 
which  is  on  tour  in  California,  and  was  a 
speaker  at  the  after  dinner  program. 

Survivors  are  his  widow,  Mae;  one  daugh- 
ter, Mrs.  O.  B.  Lomison  of  Monrovia  and  Mrs. 
Charles  Bailey  of  Beverly  Hills,  Calif.;  and 
two  sisters,  Mrs.  F .W.  Rockwell  and  Mrs. 
Floyd  Erickson  of  Hollywood. 

Dr.  Bobb  also  preceded  in  death  by  another 
brother.  Dr.  E.  V.  Bobb.  He  died  in  1939  at 
Alhambra,  Calif.,  and  previously  had  been  a 
Mitchell  resident,  practicing  as  an  ear,  eye 
and  throat  specialist. 


— 132  — 


RECENT  ADVANCES  IN  CARDIAC 
SURGERY* 

Dwight  C.  McGoon,  M.D. 
Section  of  Surgery 
Mayo  Clinic 
Rochester,  Minnesota 


Sir  James  Paget  was  an  outstanding  med- 
ical man  of  his  day,  and  made  many  notable 
contributions;  but  one  of  his  statements  made 
in  1897  is  of  particular  interest  in  the  light 
of  the  developments  of  the  last  two  decades: 
“Surgery  of  the  heart  has  reached  the  limits 
set  by  nature  to  all  surgery  . . . In  con- 
tradiction to  his  bleak  outlook,  remarkable 
achievements  have  since  been  made  in  sur- 
gery of  the  heart. 

The  discovery  of  the  feasibility  of  intra- 
cardiac surgery  is  having  an  impact  on  the 
medical  profession  not  unlike  the  impact 
which  the  discovery  of  America  must  have 
had  on  the  explorers  and  geographers  of  an 
earlier  day.  The  event  has  stimulated  an 
avalanche  of  activity  in  the  study  and  ap- 
plication of  the  technics  involved,  which  in 
turn  has  stimulated  advances  in  the  diagnosis 
and  evaluation  of  patients  with  heart  disease. 
Some  of  this  activity  undoubtedly  will  prove 
to  be  misdirected,  just  as  was  the  costly  geo- 
graphic search  for  a Northwest  Passage;  but 
from  it  all,  certain  basic  concepts  and  prin- 
ciples are  already  arising. 

Acquired  Heart  Disease 
Mitral  Stenosis.  — Among  those  forms  of 
acquired  heart  disease  which  are  amenable  to 

* Read  at  the  meeting  of  the  South  Dakota  Society 
of  Internal  Medicine,  Sioux  Falls,  South  Dakota, 
September  14,  1957. 


surgical  correction,  first  and  foremost  both 
numerically  and  historically  stands  mitral 
stenosis.  It  now  can  be  said  with  assurance 
that  what  would  seem  obvious  is  true; 
namely,  that  the  treatment  of  mitral  stenosis 
by  operation  produces  a definite  benefit  to 
the  patient. 

Studies  which  my  associates  Ellis  and  Kirk- 
lin  have  made  of  patients  operated  on  at  the 
Mayo  Clinic  show  clearly  that  the  mean  left 
atrial  pressure,  the  resting  mean  pulmonary 
artery  pressure,  and  the  pulmonary  arteriolar 
resistance  all  fall  to  or  toward  normal  values 
following  adequate  surgical  relief  of  the 
stenosis. 

The  surgical  technic  for  the  relief  of  mitral 
stenosis  has  become  rather  uniform.  The 
fused  commissures  of  the  valve  are  opened 
by  the  index  finger  inserted  into  the  heart 
through  the  left  atrial  appendage.  More  and 
more  it  has  proved  advantageous  to  facilitate 
the  opening  of  the  commissure  by  means  of  a 
special  knife  nestled  along  the  curve  of  the 
surgeon’s  finger.  At  the  clinic  the  knife  is 
used  to  incise  the  commissure  in  approx- 
imately 90  per  cent  of  the  operations. 

With  the  increase  of  experience  the  mor- 
tality from  mitral  commissurotomy  has  de- 
clined until  now  the  major  cause  of  opera- 
tive failure  is  the  occurrence  of  cerebral  em- 
bolism during  or  shortly  after  the  operation. 


i 


133  — 


SOUTH  DAKOTA 


Even  this  dread  complication  is  usually  pre- 
ventable by  the  skillful  handling  of  the  ap- 
pendage in  which  thrombotic  substance  might 
be  expected.  The  appendage  must  be  boldly 
incised,  without  the  application  of  clamps 
across  its  base,  and  blood  permitted  to  gush 
forth  for  a moment,  expelling  with  it  any 
loose  or  friable  thrombotic  material.  Only 
then  is  the  surgeon’s  finger  plunged  into  the 
opening  to  stop  the  flow  of  blood  and  to  per- 
form the  necessary  manipulations. 

One  cannot  review  the  present  status  of 
the  surgery  of  mitral  stenosis  without  con- 
sidering the  question  that  so  many  patients 
ask:  “Will  the  stenosis  recur?”  It  is  extremely 
difficult  to  obtain  accurate  data  on  this  point, 
both  because  of  the  difficulty  in  assessing  the 
adequacy  of  the  original  operation  and  be- 
cause of  the  difficulty  in  the  objective  assess- 
ment of  the  postoperative  improvement  de- 
rived. It  is  unquestionably  true  that  a bona 
fide  recurrence  of  stenosis  develops  in  an 
occasional  patient,  with  reappearance  of  the 
typical  symptoms  and  signs  after  several 
years  of  relief  following  the  first  operative 
procedure.  These  patients  are  candidates  for 
reoperation,  and  a.  satisfactory  result  from 
the  repeated  procedure  may  be  expected.  The 
technical  obstacles  at  the  second  occasion  are 
of  course  greater,  for  the  atrial  appendage  is 
now  missing.  But  by  a discipline  of  boldness, 
calmness,  and  accuracy,  the  technical  ob- 
stacles can  be  overcome. 

Mitral  Insufficiency.  — Because  a depend- 
able and  satisfactory  surgical  technic  for  the 
relief  of  mitral  insufficiency  has  not  been 
demonstrated  as  yet,  it  remains  of  fundamen- 
tal importance  to  exclude  as  candidates  for 
operation  those  patients  with  mitral  stenosis 
who  have  predominant  mitral  insufficiency. 
Should  a satisfactory  operation  for  this  con- 
dition become  available,  the  diagnosis  of  as- 
sociated minor  or  predominant  mitral  in- 
sufficiency will  become  less  interdictory.  In 
the  large  majority  of  cases  of  so-called  pure 
mitral  stenosis,  or  of  a wide-open  grossly  in- 
sufficient mitral  valve,  there  is  no  problem  of 
diagnosis.  But  when  the  two  lesions  are  pres- 
ent in  combination,  the  decision  as  to  which 
predominates  has  proved  most  difficult. 
Every  standard  sign  and  test  has  been  critic- 
ally analyzed,  including  the  systolic  murmur 
and  other  auscultatory  findings,  electrocar- 
diography, fluoroscopy,  and  even  cardiac 


catheterization;  but  all  have  proved  less  than 
reliable  in  this  differential  diagnosis.  Hope 
ran  high  that  catheterization  of  the  left  heart 
would  be  the  answer  to  this  dilemma,  but 
even  this  highly  complicated  technic  has  fal- 
len short  of  reliability. 

However,  careful  analysis  of  all  data  ac- 
cumulated in  the  cardiac  catheterization 
laboratory  of  Wood  and  associates  at  the 
Mayo  Clinic  has  resulted  in  a formula  for 
rather  accurate  differentiation  of  predomin- 
ant mitral  stenosis  from  predominant  mitral 
insufficiency  by  right  heart  catheterization 
alone.  The  test  is  based  on  the  fact  that  fol- 
lowing injection  of  dye  into  the  pulmonary 
artery,  the  plotted  contour  of  its  concentra- 
tion as  it  passes  through  a peripheral  artery 
in  the  presence  of  predominant  stenosis  re- 
sembles the  curve  which  occurs  in  normal 
persons,  but  when  insufficiency  predom-  ' 
inates,  the  disappearance  slope  of  the  curve 
is  disproportionately  prolonged.  A point  has 
been  defined  empirically  which  separates  the 
two,  and  even  with  increasing  use  this 
method  has  seldom  been  shown  to  fail  in  an 
accurate  prediction. 

We  are  all  awaiting  the  development  of  a 
surgical  technic  which  will  relieve  mitral  in- 
sufficiency. A variety  of  methods  have  been 
tried,  but  as  yet  no  uniform  procedure  has 
gained  general  acceptance.  Attempts  have 
been  made  to  insert  both  living  tissues  and 
plastic  substances  in  a “hammock”  fashion 
across  the  heart  to  make  up  for  deficient 
valve  substance;  the  mitral  annulus  has  been 
“purse  stringed”  and  plicated;  the  valve  com- 
missures have  been  sutured.  Some  success 
has  been  reported,  at  least  briefly,  but  no 
method  is  sufficiently  successful  to  warrant 
general  use  at  this  time.  Perhaps  a suitable 
prosthetic  mitral  valve  will  be  developed 
some  day. 

Aortic  Stenosis.  — Acquired  aortic  stenosis, 
like  its  mitral  counterpart,  is  a mechanical 
abnormality  which  has  come  into  the  purview  ■- 
of  the  surgeon.  Unfortunately,  the  aortic  ) 
valve  does  not  lend  itself  to  surgical  manipu-  ! 
lation  so  readily  as  the  mitral  valve,  and  con-  • 
sequently  the  operative  result  often  is  less  ; 
gratifying.  Even  with  increasing  experience 
across  the  country,  the  surgical  approach  to 
the  aortic  valve  has  not  become  uniform.  But  i 
in  spite  of  deficiencies,  operation  offers  the  ? 
hope  of  a favorable  result  in  the  great  ma-  i 


— 134  — 


APRIL  1958 


jority  of  cases  against  an  operative  risk  of 
5 to  10  per  cent. 

The  diagnosis  of  aortic  stenosis  is  not  dif- 
ficult, for  the  loud,  rough  aortic  systolic 
murmur  with  associated  thrill  and  the  faint 
aortic  second  sound  are  characteristic.  To 
select  a patient  with  aortic  stenosis  for  opera- 
tive intervention,  however,  requires  a more 
precise  definition  of  the  degree  of  stenosis 
present.  Formerly  this  required  the  compli- 
cated technic  of  catheterization  of  both  the 
left  and  right  sides  of  the  heart.  It  now  proves 
to  be  much  simpler  and  probably  safer  to 
determine  the  gradient  across  the  aortic  valve 
by  direct  left  ventricular  puncture  through 
the  anterior  thoracic  wall  with  simultaneous 
measurement  of  the  femoral  artery  pressure. 
It  seems  incredible  that  under  local  anes- 
thesia the  plunging  of  a 19-gauge  needle 
through  the  thoracic  wall  into  the  beating  left 
ventricle  could  be  safe.  Actually,  however,  it 
has  proved  safe  and  is  tolerated  by  the  pa- 
tient as  well  as  thoracentesis.  It  is  surprising 
how  near  to  the  skin  the  left  ventricular 
cavity  lies,  for  seldom  is  more  than  an  inch 
and  a half  of  needle  required  to  reach  it. 

From  the  data  thus  obtained,  a decision 
can  be  made  on  the  advisability  of  surgical 
intervention.  In  general,  a gradient  across 
the  aortic  valve  of  less  than  50  mm.  of  mer- 
cury indicates  the  presence  of  minimal  aortic 
stenosis,  and  operation  probably  is  inad- 
visable. However,  should  the  pressure  in  the 
left  ventricle  be  230  mm.  of  mercury,  for 
example,  while  the  aortic  pressure  is  130, 
thus  giving  a left  ventricular-aortic  gradient 
of  100  mm.,  the  indication  for  operation  would 
be  clear.  When  the  gradient  is  between  50 
and  75  mm.  of  mercury  each  case  must  be 
judged  on  its  individual  merits. 

Several  methods  of  approaching  the  aortic 
valve  are  available.  Originally,  Bailey  used 
the  transventricular  approach,  inserting  a 
dilating  instrument  into  the  aortic  orifice  via 
a stab  wound  in  the  left  ventricle,  and  there 
opening  the  blunt  blades  of  the  instrument. 
Dissatisfaction  with  this  technic  led  to  the 
development  of  two  approaches  through  the 
aorta  itself,  the  first  by  suturing  a rubber 
diverticulum  to  the  aortic  wall  through  which 
the  finger  could  be  inserted,  and  the  second, 
which  involved  hypothermia  and  occlusion  of 
inflow,  by  cross-clamping  and  incision  of  the 
aorta  to  expose  the  valve.  However,  it  does 


little  good  to  involve  added  risks  by  attempt- 
ing directly  to  expose  a thickened  calcified 
valve;  my  associates  and  I,  therefore,  believe 
that  the  original  transventricular  approach 
to  the  valve  is  the  best.  An  improved  aortic 
dilator  is  inserted  through  a small  stab  wound 
near  the  apex  of  the  left  ventricle.  The  in- 
strument can  be  inserted  and  positioned,  the 
valve  dilated,  and  the  instrument  withdrawn 
in  a short  interval,  with  remarkably  little  in- 
sult to  the  overburdened  heart. 

Aortic  Insufficiency.  — Although  the  sur- 
gical treatment  for  aortic  insufficiency  is 
far  from  adequate,  currently  certain  patients 
with  severe  aortic  insuffiency  due  to  a wide- 
open  aortic  valve  should  be  selected  for  in- 
sertion of  the  Hufnagel  valve.  This  is  an  in- 
genious plastic-ball  valve  which  can  be 
inserted  readily  into  the  aorta  and  which 
effectively  prevents  regurgitation  of  blood 
across  the  valve.  The  chief  drawback  is  that 
the  valve  cannot  be  inserted  in  the  ascending 
aorta,  since  the  coronary  flow  during  diastole 
would  be  drastically  curtailed.  As  the  valve 
consequently  must  be  inserted  in  the  de- 
scending aorta,  it  can  at  best  eliminate  only  a 
portion  of  the  total  regurgitant  flow.  Perhaps 
here,  as  with  mitral  insufficiency,  the  ul- 
timate surgical  treatment  will  involve  the 
replacement  of  the  diseased  valve  itself  with 
a substitute  prosthetic  valve. 

Coronary  Artery  Disease.  — With  regard  to 
the  present  role  of  surgery  in  the  treatment 
of  coronary  artery  disease,  perhaps  I can  best 
represent  our  judgment  by  saying  that  we,  at 
the  Mayo  Clinic,  are  not  performing  this  type 
of  operation.  The  wide  variety  of  procedures 
that  have  been  proposed,  recommended,  and 
then  dropped  is  highly  significant.  Total 
thyroidectomy,  resection  of  sympathetic  pain 
fibers,  grafts  of  various  tissues  to  the  surface 
of  the  heart,  creation  of  pericardial  adhesions 
by  mechanical  and  chemical  abrasion,  partial 
ligation  of  the  coronary  sinus,  production  of 
a shunt  from  aorta  to  coronary  sinus,  and  the 
implantation  of  the  internal  mammary  artery 
into  the  myocardium  are  all  procedures  which 
have  been  performed  by  others  in  the  attempt 
to  relieve  coronary  insufficiency.  Recently, 
incredible  as  it  seems,  simple  ligation  of  the 
internal  mammary  arteries  through  small 
parasternal  incisions  under  local  anesthesia 
has  been  recommended.  Certainly  this  long 
list  of  surgical  trial  balloons  bespeaks  the 


i 


— 135  — 


SOUTH  DAKOTA 


success  which  each  has  attained.  Certainly 
too,  a large  number  of  patients  urgently  need 
surgical  relief  of  coronary  insufficiency,  and 
research  along  these  lines  must  be  diligently 
pursued,  but  without  subjecting  these  in- 
dividuals to  surgical  manipulations  of  highly 
questionable  and  unproved  value. 

Aortic  Aneurysms.  — Both  in  the  thorax 
and  the  abdomen  these  lesions  are  being 
treated  surgically  with  considerable  success. 
When  occlusion  of  the  aorta  above  the  level 
of  about  the  eighth  thoracic  vertebra  is  re- 
quired, it  is  necessary  to  employ  hypothermia 
as  a precaution  against  the  effects  of  ischemia 
of  the  spinal  cord.  This  is  not  necessary  for 
aneurysms  of  the  abdominal  aorta,  and  the 
vast  majority  of  these  involve  only  that  por- 
tion of  the  aorta  beyond  the  renal  arteries. 
Clinicians  are  discovering  and  referring  for 
operation  an  increasing  number  of  such  pa- 
tients, and  the  evidence  demonstrating  the 
beneficial  influence  of  prophylactic  operation 
for  abdominal  aortic  aneurysms  has  recently 
been  brought  up  to  date  by  my  associate. 
Dr.  J.  E.  Estes.  It  appears  that  we 
now  are  undergoing  a gradual  transition 
away  from  the  use  of  homografts  in  the  re- 
pair of  aortic  lesions  to  the  employment  of 
the  increasingly  satisfactory  prostheses  which 
have  been  devised.  Occasional  rupture  of  a 
homograft  early  in  the  postoperative  period 
has  been  the  major  influence  in  our  prefer- 
ence for  specially  manufactured  prostheses 
as  aortic  substitutes. 

Congenital  Heart  Disease 

To  see  the  repaired  human  heart  which  a 
minute  before  was  limp  and  totally  quiet, 
with  an  incision  in  one  of  its  chambers 
through  which  the  surgeon  was  repairing  an 
intracardiac  defect,  take  up  its  rhythmic  ac- 
tivity for  a lifetime  is  tremendously  thrilling. 
Even  when  the  newness  and  glamor  of  this 
operative  procedure  have  worn  off,  that  will 
surely  remain  an  awesome  sight.  Those  who 
have  contributed  to  this  accomplishment 
should  feel  justly  proud. 

One  of  the  most  remarkable  results  from 
the  development  of  ability  to  perform  whole- 
body  perfusion  and  intracardiac  operations 
has  been  the  appearance  of  so  many  patients 
in  need  of  this  type  of  treatment.  Coincident 
with  this  upsurge  of  interest  in  congenital 
cardiac  anomalies  has  come  the  opportunity 
to  accumulate  considerable  new  knowledge 


of  these  lesions  — = knowledge  of  value  to  both 
surgeon  and  internist. 

Perhaps  the  best  way  to  discuss  the  more 
common  congenital  heart  diseases  is  to  divide 
them  into  three  groups,  the  first  including 
lesions  of  the  great  vessels  near  the  heart, 
the  second,  septal  defects,  and  third,  pulmonic 
stenosis  with  and  without  ventricular  septal 
defect. 

Lesions  of  the  Great  Vessels.  Patent  Ductus 
Arteriosus.  — As  is  well  known,  the  patent 
ductus  arteriosus  represents  a failure  of  ob- 
literation of  the  normally  patent  fetal  ductus, 
which  permits  after  birth  a shunting  of  oxy- 
genated blood  from  the  aorta  to  the  low- 
pressure  vascular  bed  of  the  lungs.  This  is 
the  classic  simplest  example  of  the  so-called 
left-to-right  shunt,  or  pulmonary  recircula- 
tion. A clear  understanding  of  the  patho- 
physiology associated  with  this  intrinsically 
simple  lesion  provides  one  with  a basic  under- 
standing of  the  pathophysiology  of  any  defect 
permitting  a similar  shunt.  A portion  of  the 
blood  ejected  by  the  left  ventricle  passes  via 
the  ductus  into  the  pulmonary  artery, 
through  the  lungs,  and  then  via  the  pulmon- 
ary veins  and  left  atrium  again  to  the  left 
ventricle.  The  amount  of  blood  shunted  de- 
pends on  the  diameter  of  the  lumen  of  the 
ductus  and  on  the  pressure  gradient  across 
the  defect.  Because  of  the  shunt,  the  left  ven- 
tricle must  pump  a larger  volume  of  blood 
than  actually  is  delivered  to  the  systemic 
circulation.  This  increased  work  load  on  the 
left  ventricle  is  evidenced  by  hypertrophy 
of  its  walls.  This  type  of  increased  work  load, 
which  is  the  so-called  left  ventricular  dias- 
tolic overload,  can  be  detected  accurately  by 
means  of  the  electrocardiogram,  as  demon- 
strated by  the  Mexican  school  of  electrocar- 
diography. For  this  and  other  reasons,  elec- 
trocardiography has  come  to  occupy  a pre- 
eminent position  among  the  various  pro- 
cedures performed  in  the  diagnosis  and  selec- 
tion for  operation  of  patients  with  congenital 
heart  disease. 

In  some  patients  the  pulmonary  vascular 
bed  responds  to  the  augmentation  of  pulmon- 
ary blood  flow  which  accompanies  any  left- 
to-right  shunt  by  developing  in  the  smaller 
pulmonary  vessels  intimal  and  medial 
changes  which  cause  luminal  narrowing  and 
hence  increased  resistance  to  blood  flow.  As 
this  process  goes  on,  pressure  in  the  pul- 


— 136  — 


APRIL  1958 


monary  artery  rises;  in  so  doing  it  decreases 
the  pressure  gradient  across  the  defect;  and 
thus  it  reduces  the  volume  of  the  left-to-right 
shunt.  As  the  pulmonary  artery  pressure 
rises  until  it  approaches  the  systemic  pres- 
sure, an  increasing  amount  of  blood  is 
shunted  also  from  right  to  left  (resulting  in  a 
mixed  shunt),  and  with  still  further  progres- 
sion of  the  process,  the  volume  of  the  right- 
to-left  shunt  comes  to  exceed  that  of  the  left- 
to-right  shunt  and  cyanosis  may  appear.  At 
this  time  the  defect  is  acting  as  a valve  to 
prevent  excessive  pressures  in  the  pulmon- 
ary arterial  tree,  and  it  is  our  belief  that  sur- 
gical closure  of  such  a defect  at  this  stage  is 
a disservice  to  the patient.  Hence  a pre- 
dominant right-to-left  shunt  without  asso- 
ciated electrocardiographic  evidence  of  left 
ventricular  diastolic  overload  indicates  in- 
operability. Of  extreme  interest  is  the  fact 
that  during  the  just-described  period  of  in- 
creasing pulmonary  hypertension,  with  the 
attendant  decrease  in  magnitude  of  the  left- 
to-right  shunt,  the  clinical  status  of  the  pa- 
tient apparently  improves.  The  heart  size 
returns  to  normal  and  the  patient’s  tolerance 
of  exercise  and  activity  increases;  yet  the 
prognosis  is  rapidly  worsening.  Such  pa- 
tients are  almost  urgently  in  need  of  surgical 
repair  of  their  lesion  before  time  permits  de- 
terioration of  their  status  to  that  of  inoper- 
ability. 

The  multiple  ligation  or  division  of  a patent 
ductus  is  a neat,  clean,  low-risk  procedure  in 
the  uncomplicated  situation,  with  complete 
cure  resulting.  But,  like  the  appendectomy, 
under  certain  circumstances  it  can  present 
a challenge  to  the  technical  skill  of  the  sur- 
geon. 

Coarctation  of  the  Aorta.  — • Space  does  not 
not  permit  a discussion  of  the  several  points 
of  interest  in  the  treatment  of  coarctation  of 
the  aorta.  Suffice  it  to  say  that  more  than  a 
decade  of  experience  has  shown  beyond  any 
doubt  that  the  surgical  relief  of  this  anomally 
is  possible,  and  with  risk  sufficiently  low  to 
allow  operation  in  all  but  the  most  unusual 
situations.  Here  the  judgment,  skill,  and 
technical  ability  of  the  surgeon  are  of  the 
highest  importance. 

Septal  Defects.  ■ — Embryologically,  the  de- 
velopment of  the  septa  which  divide  the 
chambers  of  the  heart  into  their  left  and  right 
halves  is  somewhat  complex,  and  it  is  per- 


haps not  surprising  that  defects  occur  not  in- 
frequently in  these  septa.  A defect  may  be 
located  in  nearly  any  portion  of  the 
atrial  septum,  it  may  be  large  or  small,  and 
the  rim  of  the  defect  may  be  deficient  about 
a portion  of  its  circumference.  The  atrial  sep- 
tum separates  chambers  which  differ  little  in 
respect  to  their  interior  pressures;  yet  be- 
cause many  defects  in  the  interatrial  septum 
are  of  relatively  large  size,  and  because  flow 
across  the  defect  is  permitted  virtually 
throughout  the  cardiac  cycle,  large  volumes 
of  blood  may  be  shunted.  As  much  as  85  to 
90  per  cent  of  the  pulmonary  blood  flow  may 
consist  of  blood  shunted  from  the  left  atrium. 
Shunted  blood  does  not  pass  through  the  left 
ventricle  in  this  anomaly,  so  it  remains  nor- 
mal in  size,  with  the  hypertrophy  and  dilata- 
tion involving  only  the  right  atrium  and  ven- 
tricle. Serious  trouble  during  infancy  from 
an  atrial  septal  defect  is  uncommon,  and  real 
difficulty  may  not  be  encountered  until  the 
second,  third  or  fourth  decade  of  life.  We 
have  repaired  successfully  atrial  defects  in 
patients  in  their  50’s.  Auricular  arrhythmias, 
dyspnea  on  exertion,  and  finally  right  heart 
failure  are  the  serious  manifestations  of  the 
presence  of  an  atrial  septal  defect.  Even  be- 
fore such  symptoms  may  be  noted,  a mur- 
mur is  produced  as  the  result  of  the  large 
volume  of  blood  passing  through  the  pulmon- 
ary valve  area;  and  this  should  lead  to  an  in- 
vestigation of  its  cause.  The  diagnosis  is 
based  on  the  blowing,  systolic  murmur  in  the 
pulmonary  area,  on  the  roentgenologic  evi- 
dence of  enlargement  of  the  right  atrium  and 
ventricle  and  the  pulmnnary  artery,  with  in- 
creased vascularity  of  the  lungs,  and  on  elec- 
trocardiographic indications  of  the  right 
bundle  branch  block.  Increasing  experience 
makes  possible  the  establishment  of  the  diag- 
nosis and  the  recommendation  of  treatment 
without  the  need  for  cardiac  catheterization 
in  the  majority  of  patients. 

For  the  treatment  of  atrial  septal  defect 
many  surgical  technics  and  manipulations 
have  been  described  and  tried,  some  of  which 
are  ingenious,  but  most  of  which  are  of  his- 
torical interest  only.  It  seems  fair  to  say  that 
only  three  methods  are  widely  employed  at 
this  time.  Many  surgeons  use  hypothermia 
and  a few  minutes  of  inflow  stasis,  during 
which  time  they  open  the  right  atrium  and 
close  the  defect  by  direct  suture.  Others  em- 


— 137  — 

4 


SOUTH  DAKOTA 


ploy  cardiopulmonary  bypass,  utilizing  some 
form  of  pump-oxygenator.  We  employ  the 
atrial  well  technic,  believing  that  this  offers 
complete  repair  with  the  least  morbidity  and 
mortality.  The  fact  that  120  patients  with  un- 
complicated atrial  septal  defect  have  had 
closure  of  their  lesion  by  this  technic  at  the 
clinic  with  loss  of  only  two  patients  persuades 
us  that  this  method  serves  us  best.  Both 
deaths  occurred  in  patients  more  than  40 
years  of  age. 

The  technic  itself  consists  of  suturing  the 
well,  made  of  rubber,  to  an  incision  in  the 
right  atrium,  from  which  the  blood  rises  into 
it,  and  through  this  bloody  pool  accurately 
suturing  a polyvinyl  sponge  (ivalon)  to  the 
margins  of  the  defect.  The  patient  is  heparin- 
ized, and  the  repair  can  be  performed  without 
haste.  The  ivalon  sponge  is  so  fashioned  that 
its  flanged  margin  overlaps  the  margin  of  the 
defect  on  its  left  atrial  side,  providing  a flap 
which  effectively  seals  the  entire  periphery 
of  the  defect.  Complete  closures  are  uni- 
formly obtained. 

A ventricular  septal  defect,  on  the  other 
hand,  often  produces  heart  failure  and  so- 
called  pneumonia  during  the  first  months 
and  years  of  life,  with  some  improvement  in 
health  thereafter,  until  advanced  pulmonary 
hypertension  may  develop.  Growth  and  gain 
of  weight  frequently  are  retarded.  In  ventri- 
cular as  well  as  atrial  septal  defect  the  diag- 
nosis is  established  and  treatment  recom- 
mended without  the  need  for  cardiac  cathe- 
terization in  the  great  majority  of  patients. 
The  characteristic  harsh  systolic  murmur, 
heard  best  in  the  left  fourth  and  fifth  inter- 
spaces parasternally,  the  enlarged  left  ven- 
tricle and  increased  pulmonary  vascular 
markings  in  the  thoracic  roentgenogram,  and 
the  typical  electrocardiographic  indications 
of  left  ventricular  diastolic  overload  are 
prominent  diagnostic  features  of  ventricular 
septal  defect. 

As  yet  only  one  technic  permits  repair  of 
these  defects,  and  this  makes  use  of  whole- 
body  perfusion  by  means  of  a pump-oxygen- 
ator. The  entire  subject  of  whole-body  per- 
fusion, or  extracorporeal  circulation,  is  fas- 
cinating, but  is  outside  the  scope  of  this  pres- 
entation. Suffice  it  to  say  that  the  machine 
we  employ  is  a modification  of  the  original 
Gibbon  apparatus,  and  we  can  affirm  with 
enthusiasm  the  fact  that  it  is  proving  em- 


inently satisfactory,  the  risk  of  the  perfusion 
alone  with  this  apparatus  being  now  probably 
only  about  2 per  cent. 

During  the  repair  of  ventricular  septal  de- 
fects, we  now  routinely  produce  cardiac 
asystole  by  the  injection  of  a solution  of  po- 
tassium citrate  into  the  coronary  circulation. 
This  greatly  facilitates  accurate,  complete  re- 
pair. Of  fundamental  importance  also  is  an 
understanding  of  the  anatomic  nature  of  the 
defect,  for  only  thus  can  closure  be  accom- 
plished in  a manner  resulting  in  the  least  dis- 
tortion and  tension  on  the  suture  line.  It  has 
become  apparent  that  in  cases  of  the  usual 
high  defect  the  line  of  closure  should  run 
transverse  to  the  outflow  tract  of  the  left  ven- 
tricle, a requirement  answered  by  suturing 
the  aortic  ring  to  the  upper  edge  of  the  ven- 
tricular septum. 

With  the  many  improvements  which  grad- 
ually have  evolved,  the  operative  mortality 
for  the  repair  of  the  ventricular  septal  defect 
has  fallen  from  18  per  cent  for  the  entire 
series  to  7 per  cent  in  the  last  30  consecutive 
cases.  The  greatest  remaining  hazard  is  the 
development  of  complete  heart  block  as  a 
result  of  injury  to  the  major  conduction  path- 
ways which  lie  at  the  margins  of  the  defect 
itself.  Even  this  complication  should  no 
longer  be  fatal  in  the  great  majority  of  pa- 
tients, although  its  treatment  requires  close 
observation  and  regulation  of  the  patient  dur- 
ing the  postoperative  period. 

Pulmonic  Stenosis.  — For  many  years  pa- 
tients with  pulmonic  stenosis  and  an  intact 
ventricular  septum  have  been  candidates  for 
pulmonary  valvulotomy  by  a blind  transven- 
tricular  approach,  and  distinct  palliation  has 
been  obtained.  Reduction  of  right  ventricular 
pressures  to  normal  levels  has  been  achieved 
but  rarely  by  this  method,  however.  An  in- 
creasing understanding  of  the  pathology  of 
the  lesion  has  shown  that  infundibular  sten- 
osis is  frequently  associated  with  the  valvular  . 
stenosis,  and  also  that  an  associated  atrial  i 
septal  defect  is  not  uncommon,  and  when  i 
present  bespeaks  a worse  prognosis.  The  | 
precondition  for  repair  of  all  of  these  possible  i 
combinations  of  lesions  is  nothing  less  than  I 
cardiac  bypass  and  whole-body  perfusion.  As  j 
a consequence,  we  increasingly  favor  this  ap- 

(Continued  on  Page  153) 


— 138  — 


I 


OBESITY  IN  CHILDREN 
Lee  Forrest  Hill,  M.D. 
Des  Moines,  Iowa 


First,  I should  like  to  express  my  appre- 
ciation for  being  invited  to  be  one  of  your 
guest  speakers  at  this  meeting.  I want  to 
talk  about  fat  children,  with  particular  em- 
phasis on  diagnosis  and  treatment. 

Obesity  may  be  encountered  at  any  age  in 
pediatric  practice.  In  infancy  it  seldom  causes 
concern  either  to  parents  or  the  physician. 
Parents,  in  fact,  are  inclined  to  view  with  ap- 
proval and  no  little  pride  the  overweight  in- 
fant who  eagerly  consumes  large  quantities 
of  food.  Such  accomplishments  are  looked 
upon  as  indications  of  health  at  its  best. 

The  physician’s  lack  of  concern  stems  from 
his  knowledge  that  the  obesity  of  the  first 
year  of  life  is  almost  certainly  transitory  and 
will  diminish  with  the  increased  activity  and 
lessened  appetite  which  can  confidently  be 
expected  during  the  second  and  preschool 
years.  Stuart^  feels  that  the  chief  signficance 
of  obesity  in  the  young  infant  with  an  exces- 
sive appetite  appears  to  be  the  indication  that 
the  infant  readily  responds  to  a positive 
caloric  balance  by  storing  fat.  “This,”  he 
states,  “may  be  a portent  of  obesity  to  follow 
in  adolescent  or  adult  life,  if  the  habit  of  over- 
eating is  developed  and  maintained.”  It  would 

From  the  Blank  Memorial  Hospital  for  Children, 
Des  Moines,  Iowa. 

Presented  before  the  Sioux  Valley  Medical  So- 
ciety, Sioux  City,  Iowa,  February,  1957. 

Previously  Published  in  the  Journal  “Pediatrics” 
published  by  the  Charles  C.  Thomas  Publishing 
Co.  ~ Sept.  1957. 


seem,  therefore,  that  an  indication  clearly 
exists  for  the  institution  of  parental  educa- 
tion in  the  basic  principle  of  good  nutrition 
even  at  this  early  age. 

Obesity  in  the  preschool  years  is  relatively 
uncommon.  Thinness  rather  than  obesity 
is  the  characteristic  of  this  age  period.  During 
the  early  school  years  susceptible  children, 
rather  insidiously  at  first,  begin  to  show  the 
trend  for  excessive  fat  deposition.  Its  peak 
incidence  occurs  roughly  between  the  years 
of  8 and  14.  Many  of  these  children  will,  dur- 
ing the  next  few  years,  gradually  lose  their 
obesity  and  emerge  as  young  adults  with 
quite  acceptable  figures  (Fig.  1).  Whether 
this  comes  about  as  a voluntary  reduction  in 
caloric  intake  or  is  the  result  of  a readjust- 
ment in  physiology  of  the  body  is  not  quite 
clear. 

Obese  children  are  referred  to  the  pediatri- 
cian by  other  physicians  or  they  are  brought 
by  worried  parents,  frequently  with  the  ob- 
servation that  there  must  be  something  wrong 
with  the  child’s  glands;  excessive  deposition 
of  fat  may  also  be  noted  as  a gradually  de- 
veloping phenomenon  in  a child  being  cared 
for  by  the  pediatrician  in  his  own  practice. 

Frankly  obese  children  usually  pose  no 
diagnostic  problem.  Their  adiposity  is  ap- 
parent at  a glance.  In  some  children,  how- 
ever, clinical  differentiation  between  fatness 
on  the  one  hand  and  stoutness  or  stockiness 


— 139  — 


.It 


SOUTH  DAKOTA 


Fig.  1.  Illustrates  gradual  storage  of  fat  in  early 
pre-adolescent  and  adolescent  years.  Loss 
of  excess  fat  by  late  adolescence.  Gain  of 
15  pounds  between  8 and  9.  No  reducing 
diet  attempted. 

on  the  other  may  present  certain  difficulties. 
Overweightness  cannot  always  be  interpreted 
correctly  as  being  synonymous  with  obesity. 
When  this  point  was  under  discussion  at  a 
Colloquy  on  Obesity  at  Iowa  State  College  a 
few  years  ago,  one  of  the  speakers  of  national 
repute  and  an  authority  in  the  field  recom- 
mended “pinching”  in  an  appropriate  site  as 
a diagnostic  technic  of  considerable  merit.  In 
the  discussion  that  followed  it  was  pointed 
out  that  such  a maneuver  in  adult  patients, 
particularly  of  the  female  sex,  ran  the  risk  of 
misinterpretation  unless  the  purposes  of  the 
examiner  were  carefully  explained  in  ad- 
vance. Pediatricians  who  confine  their  prac- 
tices to  the  generally  accepted  age  group 
should  be  relatively  free  from  such  mis- 
understanding, and  hence  may  use  “pinching” 
for  whatever  it  is  worth  as  a means  of  dif- 
ferentiating between  subcutaneous  fat  and 
muscle. 

Properly  taken  roentgenograms  and  meas- 
urements with  skin  calipers  have  been  em- 
ployed to  estimate  the  thickness  of  the  fat 
layer,  but  these  technics  would  appear  to  be 
more  useful  as  research  tools  than  as  prac- 
tical procedures  in  the  office. 


For  the  detection  of  obesity  in  its  early 
stages  of  development,  the  use  of  standard 
growth  charts  is  advantageous.  Being  from 
Iowa  it  is  but  natural  that  I should  use  the 
Iowa  growth  charts.  I am  quite  willing  to 
concede,  however,  that  there  are  other  types 
equally  good.  A single  set  of  measurements 
is  not  likely  to  be  very  rewarding,  since  it 
fails  to  reveal  what  has  gone  on  before,  but 
a series  of  recorded  periodic  measurements 
of  height  and  weight  permits  comparison  of 
expected  increment  increases  regardless  of 
body  build,  and  hence  permits  early  recog- 
nition of  a trend,  whether  up  or  down.  Excess 
storage  of  fat  is  suggested  when  the  weight 
curve  continues  to  rise  unaccompanied  by  a 
corresponding  rise  in  the  height  curve  (Fig. 
2).  In  my  experience  growth  charts  kept  in 


Fig.  2.  This  girl  gained  35  pounds  between  7 and 
9 years.  Only  6%  pounds  in  the  next  2 
years.  Good  cooperation  in  eliminating 
high  calorie  non-essential  foods. 

this  way  have  been  a most  effective  visual 
means  of  calling  the  attention  of  both  parent 
and  child  to  an  undesirable  trend,  and  it  has 
been  relatively  easy  to  enlist  their  interest  in 
simple  preventive  measures  at  this  early 
stage. 

Having  reached  the  conclusion  that  his  pa- 
tient merits  the  designation  “obese,”  the  phys- 
ician’s next  task  is  to  determine  if  possible 


— 140  — 


APRIL  1958 


the  reason  for  the  obesity.  In  spite  of  repeated 
assertions  to  the  contrary  the  belief  persists 
strongly  among  lay  people,  less  so  among 
physicians,  that  endocrine  dysfunction  is  a 
frequent  cause  of  obesity.  All  of  us  here  un- 
doubtedly have  had  the  experience  repeat- 
edly of  parents’  bringing  their  fat  children  to 
us  with  the  complaint  of  “gland”  trouble. 
Even  children  referred  by  physicians  not  in- 
frequently have  had  a trial  on  thyroid  med- 
ication. There  are,  of  course,  endocrine  and 
hypothalamic  disturbances  which  include 
obesity  among  their  manifestations,  but  they 
are  extremely  rare  and  account  for  only  a 
small  percentage  of  the  total  cases.  Moreover, 
their  symptomatology  and  physical  signs  dif- 
fer so  markedly  from  simple  obesity  that  dif- 
ferentiation on  clinical  grounds  alone  is 
usually  possible. 

Among  the  endocrinopathies,  hypothyroid- 
ism is  most  often  suspected.  Yet  the  clinical 
appearance  of  the  hypothyroid  child  as  con- 
trasted with  the  usual  obese  child  is  striking 
indeed.  The  fat  child  is  usually  tall  for  his 
age,  his  complexion  is  ruddy,  and  he  is  alert 
mentally.  Fat  deposits  are  most  marked  over 
breasts,  hips,  abdomen  and  pubic  area  where 
the  genitals,  although  of  normal  size,  may  be 
nearly  hidden.  Many  obese  children  stand  in 
a position  of  genu  valgum.  Basal  metabolic 
rates  are  normal  or  above  normal  if  appro- 
priate standards  are  used.  Blood  pressure 
readings  are  usually  at  the  upper  margin  of 
normal  or  are  moderately  elevated  although 
normal  values  may  be  attained  if  appropriate 
width  cuffs  are  used.  Concentrations  of 
cholesterol  in  the  serum  are  normal  and  bone- 
age  is  normal  or  slightly  advanced.  In  con- 
trast, the  hypothyroid  child  may  be  over- 
weight but  this  is  due  to  myxedema,  not  fat. 
His  skin  is  pale  and  cold  and  he  is  sluggish 
mentally.  Appetites  are  usually  small. 
Talbot^  states  that  older  hypothyroid  chil- 
dren may  rarely  have  positive  caloric  bal- 
ances and  storage  of  fat  because  their  ap- 
petites may  not  diminish  in  proportion  to  the 
diminution  in  energy  metabolism.  Wilkins^ 
says  he  has  seen  only  two  obese  children  in 
over  200  with  definite  hypothyroidism. 

Some  years  ago  it  was  a common  practice 
to  label  obese  juvenile  boys  with  hidden  geni- 
tals as  examples  of  “Froehlich’s  syndrome.” 
This  came  about  as  the  result  of  a paper  pub- 
lished in  1901  by  Froehlich^-  in  which  he  des- 


cribed a fat  boy  with  hypogenitalism.  His  pa- 
tient, however,  had' a craniopharyngioma  in- 
volving the  hypothalimus.  In  addition  to  the 
obesity  and  delayed  sexual  maturation,  other 
manifestations  of  this  type  of  lesion  were  also 
present,  such  as  impaired  vision,  headache, 
vomiting  and  distortion  of  the  dorsum  sellae 
turcicae.  The  term  “Froehlich’s  syndrome” 
should  not  be  applied  to  children  with  simple 
dietary  obesity,  but  should  be  reserved  for 
children  who  exhibit  the  signs  and  symptoms 
originally  described  by  Froehlich. 

Cushing’s  disease  is  an  endocrinopathy  in 
which  adiposity,  especially  about  the  face 
and  neck,  is  one  of  the  cardinal  manifesta- 
tions. As  everyone  here  has  become  thorough- 
ly familiar  with  the  characteristics  of  this  di- 
sease through  its  iatrogenic  production  from 
steroid  therapy,  it  need  not  be  discussed 
further.  Talbot2  states  that  only  18  authen- 
ticated spontaneously  acquired  pedriatric 
cases  have  been  recorded  in  the  last  25  years. 

Another  disorder  associated  with  obesity  is 
the  Laurence-Moon-Biedl  syndrome.  How- 
ever, these  rare  cases  classically  have  such 
other  manifestations  as  retinitis  pigmentosa, 
mental  deficiency  and  polydactylism  and 
should  therefore  cause  little  trouble  in  being 
differentiated  from  simple  dietary  obesity. 
While  hypothalmic  disorders  and  endocrine 
dysfunctions  or  the  type  just  discussed  are  ad- 
mittedly rare,  nevertheless  they  do  occur  and 
should  be  carefully  considered  by  the  clin- 
ician in  the  evaluation  of  the  obese  patient. 

Now  let  us  turn  our  attention  back  to  the 
group  of  adolescent  children  who  are  phys- 
ically normal  with  the  exception  of  obesity. 
Before  the  clinician  can  set  up  a rational 
therapeutic  approach  it  is  essential  that  he 
determine,  if  possible,  the  cause  or  causes 
which  have  led  to  the  obesity.  In  the  broad 
sense,  it  may  be  said  that  obesity  from  any 
cause  must  be  the  result  of  excessive  caloric 
intake  or  to  decreased  expenditure  of  energy. 
Excessive  intake,  hyperphagia  or  just  plain 
overeating,  may  have  several  explanations. 
Earlier,  I mentioned  Stuart’s  idea  that  habit 
having  its  inception  in  infancy  may  carry  on 
into  later  childhood  and  even  into  adult  years. 
Children  may  acquire  the  habit  of  overeat- 
ing in  later  years  or  the  excess  calories  may 
have  their  source  in  the  eating  habits  of  the 
family.  “Mrs.  Jones  sets  a good  table”  may 
mean  the  serving  of  an  overabundance  of 


— 141  — 


SOUTH  DAKOTA 


high  calorie  foods  both  for  her  own  and  her 
family’s  enjoyment.  Even  where  there  is  a 
vehement  denial  that  the  obese  child  eats 
excessively  at  the  table,  it  is  usually  possible 
to  elicit  an  admission  of  a craving  for  sweets, 
frequent  raids  on  the  refrigerator  for  snacks, 
or  daily  visits  to  the  neighborhood  drugstore 
for  ice  cream  sodas.  Whatever  the  circum- 
stances responsible  for  establishing  the  habit 
of  overeating,  it  becomes  progressively  more 
fixed  and  increasingly  difficult  to  correct. 
BruchS  states  that  approximately  50%  of 
obese  children  eat  excessively  because  of 
psychogenic  disturbances.  Food  is  resorted 
to  as  a relief  from  anxiety  states.  She  feels 
that  the  gain  in  weight  sometimes  seen  after 
tonsillectomy  is  on  this  basis.  It  is  this  group 
who  are  most  resistant  to  therapeutic  man- 
agement. Little  hope  of  success  can  be  en- 
tertained until  the  underlying  emotional 
problem  is  uncovered  and  resolved. 

Decreased  expenditure  of  energy  results 
from  insufficient  exercise  either  voluntary  or 
because  of  illness.  Most  obese  children  have 
sedentary  habits.  They  are  clumsy  and 
awkward  and  lack  the  coordination  of  the 
athlete.  They  are  not  sought  after  by  their 
contemporaries  for  participation  in  athletic 
pursuits,  hence  they  resort  to  other  interests 
of  a sedentary  nature  such  as  reading  or 
music  where  they  are  not  at  a disadvantage. 
Some  undoubtedly  seek  satisfaction  in  eating 
as  a compensation  for  lacks  in  other  direc- 
tions. To  entice  these  children  into  forms 
of  exercise  which  will  permit  greater  ex- 
penditure of  energy  is  sometimes  a difficult 
task.  The  situation  isn’t  helped  any  by  the 
critical  attitude  of  fathers,  disillusioned  of 
their  earlier  visions  of  a star  athlete  in  the 
family. 

Illnesses,  such  as  rheumatic  fever,  which 
require  long  periods  of  rest  in  bed,  and  var- 
ious muscular  abnormalities  which  impose 
inactivity  may  result  in  obesity  because  of 
less  expenditure  of  energy  than  intake.  Wil- 
kins® cites  the  case  of  a 6-year-old  boy  with 
amyotonia  congenita  who  weighed  53  kg.  and 
whose  body  “was  largely  a lump  of  fat.” 

In  addition  to  excessive  caloric  intake  and 
decreased  expenditure  of  energy  as  a cause 
for  obesity,  the  clinician  must  evaluate  the 
etiologic  role  of  the  genetic  or  constitutional 
factor.  I do  not  have  any  accurate  data  from 
my  own  practice,  but  my  impression  is  that 


the  tendency  to  stoutness  and  obesity  repre- 
sents a strong  familial  trait.  Obesity  in  one 
or  both  parents  or  in  a close  relative  is,  I 
should  say,  the  rule  rather  than  the  excep- 
tion. I am  sure  all  of  us  have  been  intrigued 
by  the  observation  that  one  person  can  con- 
sume what  appears  to  be  a huge  quantity  of 
food  and  remain  thin  while  another  eats  the 
same  amount  or  less  and  stores  fat.  What  the 
genetic  or  physiologic  factors  may  be,  and 
how  they  operate  to  permit  these  differences 
is  not  clear.  Occasionally  one  encounters  an 
obese  child  where  the  parents’  denial  of  ex- 
cessive eating  seems  to  be  substantiated.  An 
illustration  is  a 4-year-old  boy  whom  I saw 
recently.  He  weighed  26  kg.  and  was  ob- 
viously obese.  His  mother  was  sure  that  he 
ate  no  more  than  other  children  of  his  age, 
and  that  his  activity  was  similar  to  theirs. 
After  a reasonably  careful  work-up  it  was 
concluded  that  he  fell  in  the  classification  of 
dietary  obesity.  A suitable  diet  for  his  age 
and  ideal  weight  was  arranged  by  the  hos- 
pital dietition.  At  the  return  visit  a couple  of 
weeks  later  the  mother  complained  that  the 
diet  contained  too  much  food  — she  had  been 
unable  to  persuade  him  to  eat  all  of  it.  So 
far  as  I know  no  evidence  has  been  advanced 
to  show  that  there  is  an  inherent  difference  in 
the  metabolism  of  fat  between  obese  and  non- 
obese  individuals. 

Finally,  I should  like  to  say  a few  words 
about  the  treatment  of  obese  children.  It 
would  be  a simple  matter  indeed  if  all  that 
was  required  was  the  prescribing  of  a low 
calorie  diet.  But  unfortunately  we  are  deal- 
ing with  a child  who  is  obese  rather  than 
with  obesity  in  a child.  Regulation  of  the  diet 
meets  with  success  in  the  infant  because  he 
can’t  help  himself,  but  the  situation  is  quite 
different  with  the  young  adolescent  who  is 
far  more  interested  in  the  immediate  satis- 
faction of  his  craving  for  food  than  he  is  in 
attaining  the  remote  advantages  of  a slim 
figure  at  some  future  date  or  of  avoiding  the 
theoretic  dangers  of  a slipped  epiphysis.  At- 
tempts to  enforce  a low  caloric  diet  upon  an 
uncooperative  child  are  doomed  to  failure 
from  the  start.  Surreptitious  stealing  of  food 
may  be  resorted  to,  or  money  may  be  stolen 
to  purchase  food  at  the  store,  or  the  child 
may  seek  hand-outs  at  the  neighbors.  Even 
if  cooperation  can  be  secured,  it  usually  is 
only  temporary,  and  the  child  within  a few 


— 142  — 


APRIL  1958 


Fig.  3.  Child  fat  from  infancy.  Both  mother, 
father  and  brother  obese.  Excess  eating  by 
whole  family.  Temporary  interest  in  losing 
weight  at  8 and  again  at  11  Vz. 

weeks  reverts  back  to  former  eating  habits 
(Fig.  3). 

There  is  a further  objection  to  severly  re- 
stricted diets  in  the  prepubescent  and  pub- 
escent years.  These  are  years  of  rapid  growth 
when  nutritional  needs,  especially  for  protein 
and  minerals,  such  as  calcium,  are  great.  Any 
diet  which  deprives  the  child  of  these  essen- 
tials during  this  period  does  more  harm  than 
good. 

Eventually,  there  comes  a time  when  most 
adolescent  children  of  their  own  free  will 
want  to  reduce  (Fig.  4).  This  is  the  age  when 
dating,  clothes,  and  appearance  all  become 
important.  It  is  the  age,  too,  when  the  rate 
of  growth  has  begun  to  decelerate.  A proper 
reducing  diet  at  this  age  will  have  more 
chance  of  success  and,  of  even  more  import- 
ance, it  will  be  nutritionally  safe.  For  the 
younger  adolescent  it  seems  to  me  the  thera- 
peuthic  approach  of  choice  should  be  to  at- 
tempt to  prevent  excessive  gains  rather  than 
to  reduce  weight.  A diet  can  be  prescribed 
which  will  be  reasonably  satisfying  to  the 
child  while  at  the  same  time  the  nutritional 
needs  of  rapid  growth  are  safeguarded.  The 
essentials  of  such  a diet  are  skimmed  milk, 


Fig.  4.  All  attempts  to  curb  appetite  unsuccessful 
until  13  years  of  age.  Father  obese. 


meat,  cheese,  eggs,  green  and  yellow 
vegetables  and  fruits.  High  caloric  foods  of 
little  nutritional  value  should  be  avoided. 
These  include  cream,  gravies,  breadstuffs  and 
sweets,  oily  salad  dressings,  butter,  potatoes, 
spaghetti  and  macaroni. 

Anorexigenic  drugs,  such  as  dextro-amphe- 
tamine  sulfate,  have  been  of  little  value  in 
my  experience.  However,  I have  prescribed 
them  only  rarely  for  I have  felt  that  the  child 
should  not  be  led  to  believe  that  a pill  three 
times  a day  before  meals  was  the  answer  to 
his  or  her  obesity  problem. 

In  summing  up  the  clinical  aspects  of 
obesity  in  children,  the  following  points  seem 
most  pertinent: 

1.  The  trend  toward  obesity  should  be  recog- 
nized as  early  as  possible.  The  keeping  of 
growth  charts  is  most  useful  for  this  pur- 
pose. Relatively  simple  corrections  in  the 
eating  habits  of  the  child  and  family  es- 
tablished early  may  prevent  a difficult  or 
impossible  task  later  on. 

2.  The  causes  of  obesity  vary  with  the  in- 
dividual child.  Overeating  either  because 
of  habit  or  an  emotional  disturbance,  lack 
of  physical  exercise,  and  a constitutional 

(Continued  on  Page  153) 


— 143  — 


SOUTH  DAKOTA 


Congressional  Candidates  Have  Their  Say 


Candidates  for  nomination  to  Congress  by 
the  two  political  parties  have  made  state- 
ments for  the  Medical  Association  as  to  their 
views  of  Medical  and  health  legislation. 

£.  Y.  Berry,  Republican,  incumbent  says, 

“I  thank  you  for  your  letter  of  February  20 
with  regard  to  my  opinions  on  free  medicine 
for  everyone  at  the  expense  of  the  Federal 
Government. 

Probably  the  easiest  way  for  me  to  give 
you  my  thinking  on  having  the  Federal  gov- 
ernment do  all  things  for  all  people  is  to 
enclose  a copy  of  my  Lincoln  week  news- 
letter. I said  there,  “We  know  that  if  we  were 
to  have  the  Federal  government  build  all  the 
schools,  hire  all  the  teachers,  build  all  the 
power  plants,  construct  all  the  sewer  systems, 
provide  the  medical  care  for  all  of  our  people, 
etc.,  that  we  would  dry  up  the  resources  of 
the  state  and  local  governments,  as  well  as 
remove  the  inventive  ability,  the  ingenuity, 
and  the  desire  of  the  individual.  We  would 
create  a static  society  such  as  has  been 
created  by  our  friends  across  the  ocean.” 

I am  definitely  opposed  to  grant-in-aid 
programs;  I am  opposed  to  having  the  Fed- 
eral government  do  anything  that  the  people 
can  do  as  well  for  themselves;  I am  opposed 
to  increasing  the  Federal  budget;  I am  op- 
posed to  programs  that  create  inflation,  in- 
crease taxes,  create  cheap  money,  and  destroy 
the  savings  of  the  American  people  through 
cheap  money  and  inflation.  I believe  we  can 
build  up  our  defenses  and  still  maintain  a 
sound  financial  position  in  this  country  by 
putting  more  business  in  government  and 
getting  the  government  out  of  business. 

I am  not  sure  this  answers  your  inquiry — 
if  there  is  any  special  program  you  would  like 
my  views  on,  I shall  be  happy  to  give  them. 
In  the  over-all,  let  me  say  that  my  belief  and 
my  vote  has  constantly  been  for  a business- 
like handling  of  our  fiscal  affairs  without  re- 
sorting to  socialistic  methods.” 

Herb  Thomas,  Democrat  of  Fort  Pierre, 
says. 


“For  your  information,  I am  unalterably 
opposed  to  what  is  known  as  “socialized” 
Medicine.  It  is  my  belief  that  the  wonders  of 
modern  medicine  should  be  made  available 
to  all  people.  However,  I do  not  believe  that 
it  is  advisable  to  make  it  a government  func- 
tion. 

Privately  operated  insurance  programs 
have  done  much  to  help  in  broadening  pro- 
tection against  sickness  and  disease.  Inade- 
quate as  it  is,  I still  think  that  it  is  a problem 
to  be  worked  out  with  private  funds  and  the 
Medical  profession. 

It  would  seem  that  this  is  a problem  of  the 
medical  profession  and  I do  not  think  that 
the  doctors  should  close  the  door  to  a sensible 
system  of  federal  aid,  such  as  in  our  social 
security  program. 

We  all  know,  who  know  any  doctors,  that 
many  of  them  contribute  generously  of  their 
skills  and  talents  to  the  unfortunate,  without 
any  hope  of  compensation.  We  should  be  able 
to  work  out  some  arrangement  whereby  a 
doctor  would  not  have  to  refuse  to  treat  a 
sick  child  merely  because  he  happened  to  be 
the  child  of  parents  who  were  temporarily 
out  of  money.  Surely  the  child  should  be 
helped,  and  the  doctor  should  not  have  to  do 
it  for  nothing. 

I think  this  can  be  accomplished  without 
resorting  to  a system  that  would  lead  to 
“socialized”  medicine. 

The  honorable  George  McGovern  present 
congressman  from  the  1st  District  says, 

“During  my  period  of  service  in  the  Con- 
gress, I have  supported  and  will  continue  to 
support  legislation  which  I believe  will  im- 
prove the  health  of  the  American  people.  I 
opposed  the  cuts  that  were  proposed  on  the 
House  Floor  in  the  last  session  of  Congress 
for  such  programs  as  the  Pure  Food  and  Drug 
Administration  and  the  research  programs  of  ! 
National  Institutes  of  Health.  I believe  that  ( 
the  Federal  Government  is  morally  obligated  i 
to  assist  with  grants  carrying  on  research  into  I 


— 144  — 


APRIL  1958 


such  dread  killers  as  cancer  and  heart  disease. 
I know  of  no  government  program  that  is 
more  worth  while  than  the  research  programs 
which  have  been  substantially  supported  by 
the  Federal  Government  that  center  in  the 
National  Institutes  of  Health. 

I think  that  all  Americans  are  shocked  in 
the  knowledge  that  10  million  of  our  citizens 
are  suffering  from  heart  disease;  cancer  has 
marked  1 out  of  every  7 of  us  as  its  victim; 
and  arthritis  and  rheumatic  diseases  cripple 
another  10  million  Americans.  No  one  can 
fully  estimate  the  anguish  resulting  from 
various  diseases  of  the  mind.  With  so  many 
millions  of  Americans  marked  for  destruc- 
tion by  these  major  diseases,  the  money  that 
we  have  spent  in  accelerating  a cure  or  pre- 
vention for  such  killers  is  money  well  in- 
vested. 

At  the  same  time,  we  can  be  tremendously 
encouraged  by  the  amazing  strides  that  med- 
ical science  has  made  in  the  field  of  health. 
Deaths  from  influenza  have  been  reduced  by 
three-fourths  since  1944;  deaths  from  appen- 
dicitis and  rheumatic  fever  have  dropped  by 
two-thirds;  fatalities  from  syphillis,  kidney 
disease,  pneumonia,  and  tuberculosis  have 
been  cut  in  half,  and  the  Nation’s  death  rate 
has  been  reduced  by  10%  while  the  average 
life  expectancy  has  been  increased  a full  five 
years.  All  of  this  has  been  accomplished  in 
the  last  decade,  and  is  a tremendous  tribute 
to  the  dedication  of  our  doctors  and  medical 
scientists. 

With  regard  to  the  principle  of  social  secur- 
ity, I joined  with  the  political  platforms  of 
both  the  Republican  and  the  Democratic  Par- 
ties in  supporting  their  basic  program.  I am 
also  in  favor  of  passage  of  the  Jenkins- 
Keough  bill,  which  would  extend  the  objec- 
tives of  the  social  security  program  to  self- 
employed  individuals,  including  doctors  and 
lawyers.  The  Jenkins-Keough  proposal  is  at 
present  still  pending  in  the  House  Ways  and 
Means  Committee,  but  I will  do  whatever  I 
can  as  one  member  of  the  Congress  to  ex- 
pedite favorable  consideration  for  this  legisla- 
tion if  and  when  we  can  bring  it  out  of  the 
Ways  and  Means  Committee. 

At  the  present  time,  there  has  been  con- 
siderable discussion  in  the  Congress  about 
providing  hospital  and  surgical  benefits  for 


aged  citizens.  It  would  seem  to  me  that  if  any 
such  program  were  to  be  considered  favor- 
ably by  the  Congress,  it  ought  to  include  a 
protective  principle,  such  as  the  deductible 
collision  insurance  provided  for  automobile 
owners.  In  other  words,  anyone  covered  by 
hospital  and  surgical  benefits  should  be  re- 
quired to  pay  a minimum  initial  portion  of 
the  fee  so  that  doctors  and  hospitals  would 
be  so  protected  against  those  citizens  who 
would  exploit  public  medical  care  of  this 
kind.  We  all  know  that  the  cost  of  automobile 
insurance  covering  every  minor  scratch  or 
dent  to  a fender  would  be  prohibitive  in  cost. 
The  same  would  doubtless  be  true  of  some  of 
the  proposals  now  before  the  Congress  ex- 
tending unlimited  benefits  to  aged  citizens. 
Before  making  any  final  decision  on  legisla- 
tion of  this  type,  I would,  of  course,  want  to 
confer  with  members  of  the  medical  profes- 
sion as  to  some  of  the  practical  considerations 
involved  in  such  a proposal.  I have  always 
had  a special  feeling  of  responsibility  to  our 
older  citizens,  but  I would  not  want  to  sup- 
port a program  designed  to  assist  them  that 
was  impractical  in  administration. 

Honorable  Joe  Foss,  Governor,  State  of 
South  Dakota  says,  many  thanks  for  your 
recent  letter  relative  to  my  position  on  mat- 
ters pertaining  to  the  practice  of  medicine. 

I am  opposed  to  socialized  medicine  and  I 
will  work  against  any  legislation  designed  to 
socialize  this  field  if  I am  elected  to  Congress. 
You  will  recall  that  during  my  administration 
legislation  was  adopted  to  permit  the  State 
Public  Welfare  Department  to  provide  med- 
ical or  remedial  care  for  recipients  of  old  age 
assistance  by  making  indirect  payments 
through  prepaid  health  insurance  or  by  mak- 
ing direct  payments  to  vendors  of  such  med- 
ical or  remedial  care  or  both. 

I have  always  been  most  happy  to  work 
closely  with  the  South  Dakota  Medical  So- 
ciety in  health  and  medical  matters,  and  I 
would  expect  to  continue  to  do  so  if  elected 
to  Congress. 

Many  thanks  for  your  interest,  and  best 
personal  regards. 


.^145  — 


South  Dakota  State  Medical  Association  Annual  Meeting 

The  Seventh-Seventh  Annual  Meeting  of  our  State  Association  will  be  held  at  Huron  May 
17th  to  May  20th,  1958. 

On  Saturday,  May  17th  and  Sunday  May  18th,  the  Council  and  House  of  Delegates  will 
meet.  All  of  the  standing  and  special  committees  of  these  bodies  will  give  their  reports  and  i 
recommendations.  From  each  of  the  twelve  Districts  your  Councillor  and  your  Delegates  will  | 
give  recommendations  and  introduce  all  proposals  that  your  district  has  directed.  Through 
the  channels  available  each  member  of  our  association  may  express  his  ideas  and  opinions. 

On  Monday  and  Tuesday  an  excellent  scientific  program  will  be  given.  You  will  have 
time  to  renew  acquaintances  within  the  state  and  by  visiting  the  exhibits  you  will  see  the  best  j 
in  medications  and  the  newest  of  instruments.  j 

How  about  making  an  effort  to  attend  all  or  part  of  the  Annual  Meeting. 

M.  M.  Morrissey,  M.D. 

Pierre,  South  Dakota 


I 


— 146  — 


CONOMICS 


PROTECTION  FROM  RADIATION 
EXPOSURES 

by  Charles  E.  Carl,  Director 
Division  of  Sanitary  Engineering 


The  Thirty-fifth  Session  of  the  Legislature 
of  the  State  of  South  Dakota,  1957,  approved 
H.B.  826  (Chapter  122,  1957  Session  Laws, 
page  188)  authorizing  the  State  Health  De- 
partment to  Provide  Protection  from  Radia- 
tion Exposures. 

Section  1 expresses  the  philosophy  of  radia- 
tion use: 

“Whereas,  radiation  can  be  instrumental 
in  the  improvement  of  health,  welfare,  and 
productivity  of  the  public  if  properly  util- 
ized, and  may  impair  the  health  of  the 
people  and  the  industrial  and  agricultural 
potentials  of  the  State  if  improperly  util- 
ized, it  is  hereby  declared  to  be  the  public 
policy  of  this  state  to  encourage  the  con- 
structive uses  of  radiation  and  to  control 
any  associated  harmful  effects.” 

The  Act  outlines  the  duties  of  the  Health 
Department  generally  as  follows: 

1.  Develop  policies  and  programs  for  deter- 
mination and  amelioration  of  hazards; 

2.  Work  with  other  governmental  agencies; 

3.  Accept  and  administer  financial  aid; 

4.  Training  and  research; 

5.  Collect  and  disseminate  information; 

6.  Adopt  regulations; 

7.  Issue  orders; 

8.  Review  design  plans  and  specifications 
upon  request; 

9.  May  inspect  radiation  sources;  and 

10.  Exercise  incidental  powers. 

The  Act  further  provides  (1)  for  the  regis- 
tration by  owners  of  all  radioactive  materials 
and  radiation  machines,  except  those  known 


to  be  without  hazard;  (2)  that  no  person  may 
give  diagnostic  or  therapeutic  radiation  un- 
less such  person  is  licensed  to  practice  the 
healing  art  or  is  a duly  licensed  dentist  in 
South  Dakota,  or  is  directly  supervised  by 
such  a person;  (3)  that  the  Health  Depart- 
ment may  inspect  sources  of  radiation;  and 
(4)  penalty  provisions. 

The  Public  Health  Advisory  Committee 
considered  their  responsibilities  under  the 
Act  and  adopted  Regulations  September  12, 
1957.  These  were  approved  by  the  Attorney 
General  September  19,  1957,  were  filed  with 
the  Secretary  of  State  September  25,  1957, 
and  became  effective  October  25,  1957. 

Among  other  items,  the  Radiation  Control 
Act  provides  for  the  registration  of  radiation 
machines  and  materials,  and  the  Regulations 
prohibit  the  use  of  shoe  fitting  machines, 
except  when  used  by  properly  qualified  per- 
sons. The  Public  Health  Advisory  Commit- 
tee, on  December  12,  1957,  authorized  the 
Health  Officer  to  initiate  appropriate  activ- 
ities to  carry  out  the  provisions  of  the  Act 
and  Regulations.  Complying  with  that  direc- 
tive 

(1)  News  releases  were  made  December  14, 
1957,  advising  of  the  general  content  of 
the  radiation  control  program,  and 
specifically  indicating  that  the  commer- 
cial use  of  “shoe  fitting  machines”  was 
prohibited; 

(2)  A directive  has  gone  to  all  County 
Board  of  Health  Superintendents, 
County  Public  Health  Nurses,  City  and 


_ 147  — 


SOUTH  DAKOTA 


County  Health  Departments  and  other 
field  personnel  in  Public  Health  re- 
questing them  to  notify  shoe  stores  in 
their  area  that  the  use  of  shoe  fitting 
machines  for  commercial  use  is  pro- 
hibited; and 

(3)  Forms  are  being  printed  to  be  used  for 
the  registration  of  machine  and  ma- 
terial radiation. 

The  S.  D.  Department  of  Health  is  working 
quite  closely  with  the  Public  Health  Service 
and  the  Atomic  Energy  Commission  in  radia- 
tion health  practices.  The  Department  is  re- 
ceiving excellent  cooperation  from  the  radio- 
isotope users  in  the  State;  the  uranium  in- 
dustry, both  mines  and  the  processing  plant 
at  Edgemont,  have  been  cooperative;  the 
owners’  of  radiation  machines,  both  private 
and  government,  have  expressed  considerable 
interest  in  these  activities;  and  the  manufac- 
turers and  distributors  of  radiation  machines 
and  materials  have  written  and  called  at  the 
State  Health  Department  with  inquiries  re- 
lative to  the  radiation  control  program.  The 
Department  of  Health,  with  other  Govern- 
mental agencies,  is  also  working  with  the 
Northern  States  Power  Co.  relative  to  their 


proposed  nuclear  fuel  power  generating  plant 
near  Sioux  Falls. 

The  South  Dakota  Department  of  Health, 
cooperating  with  the  Public  Health  Service, 
Department  of  Health,  Education  and  Wel- 
fare, is  operating  a continuous  duty  air 
sampling  station  on  the  roof  of  the  State  Cap- 
itol. This  sampling  station  is  part  of  a nation- 
wide network  of  such  stations.  During  the 
period  of  nuclear  explosions,  daily  readings 
were  taken,  results  were  forwarded  to  the 
Public  Health  Service,  and  comparable  data 
from  all  stations  in  the  network  provides  a 
nation-wide  pattern  of  radiation  fallout  be- 
fore and  after  nuclear  explosions.  The  station 
is  still  in  continuous  operation,  but  with  bi- 
weeky  readings  of  radiation  activity  now  that 
the  nuclear  explosion  series  are  completed. 

The  Department  is  quite  pleased  with  the 
excellent  cooperation  received  during  the 
inauguration  of  this  new  but  vital  public 
health  program,  and  we  are  endeavoring  to 
carry  out  the  mandate  of  the  Legislature  that 
“.  ...  it  is  hereby  declared  to  be  the  public 
policy  of  this  state  to  encourage  the  con- 
structive uses  of  radiation  and  to  control  any 
associated  harmful  effects.” 


125  mg.  15  mg 


• relaxes  the  hypertonic  uterus  thus  relieving  pain 

• furnishes  gentle  sedation 

Dosage:  one  tablet  three  times  a day  beginning  three  to  five  days  before  onset 


of  menstryotion. 


STAPHYLOCOCCAL  INFE